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MPs deliver damning verdict on PCT commissioning

By Gareth Iacobucci

MPs have accused PCTs of having ‘misplaced confidence' in their own ability in a damning verdict on the standard of NHS commissioning.

In a report summing up its recent inquiry into commissioning, the Health Committee said trusts' perceptions of how they were performing were often removed from reality, and said it was concerned about ‘complacency' among NHS managers.

The report also poured scorn on the Government's attempts to improve commissioning, and accused the Department of Health of trying to cover up the true scale of management costs in the NHS, which it estimates at 14% of overall NHS spend.

The detailed inquiry, which has heard evidence from the likes of the BMA, RCGP, and the King's Fund, plus senior civil servants and ministers, said the purchaser/provider split and the Government's commissioning policies 'may need to be abolished' if research proves they are 'uneconomic'.

The committee said there was ‘a remarkable degree of misplaced confidence on the part of PCTs about how well they think they are doing', adding: ‘We are concerned that PCTs might be too complacent to make the necessary improvements.'

It said commissioning deficiencies were caused by shortcomings in data, a lack of necessary skills, a lack of levers of influence over providers, and the impact of Government policies.

The report said: 'Research commissioned by the DH but not published estimated [management and administration costs] to be as high as 14% of total NHS costs. We are dismayed that the Department has not provided us with clear and consistent data on transaction costs; the suspicion must remain that the DH does not want the full story to be revealed.

'We were appalled that four of the most senior civil servants in the Department of Health were unable to give us accurate figures for staffing levels and costs dedicated to commissioning and billing in PCTs and provider NHS trusts. We recommend that this deficiency be addressed immediately.'

MPs said Government reforms had either stalled or blocked progress, and said PCTs had failed to engage in constructive discussions about how to improve performance of providers, including GPs.

The report also questioned the use of external consultants from the private sector, which has been encouraged via the Government's Framework for procuring External Support for Commissioners (FESC).

It said: ‘PCTs clearly do lack the skills that they need for commissioning and engaging consultants is one way of helping to address this situation. However, we are concerned that FESC is an expensive way of addressing PCTs' shortcomings.'

The committee also expressed concern that many PCTs were not absorbing and retaining skills and knowledge from the private sector, and were simply using them to plug short-term gaps in expertise.

It also warned that the Government's World Class Commissioning drive was in danger of being reduced to ‘a box-ticking exercise', and cast doubt on whether the scheme could address ‘the lack of capacity and skills at PCT-level and weak clinical knowledge'.

‘There are concerns that WCC will be no more than a "box ticking" exercise whereby people expend a lot of energy merely demonstrating they have the right policies in place, rather than actually transforming patient outcomes and cost effectiveness.'

Dr Richard Vautrey, GPC Deputy Chair, said: 'Commissioning is a key function of planning NHS services, but its purpose has been subverted through ideologically driven reforms. The purchaser-provider split, and the application of a market model to the planning of services have created unneccessary bureaucracy.

'Doctors are fed up with repeated re-organisations, which has not allowed commissioners to build up experience and expertise. There have been too many central initiatives that have been the focus for local managers, rather than the commissioning itself.'

But NHS bosses criticised the report's conclusions.

Steve Barnett, chief executive of the NHS Confederation, said: 'We do not feel the findings of the report accurately reflect the improvements made to progress commissioning in recent years.''

A Department of Health spokesperson said: 'Commissioning is improving and there are many examples of PCTs across the country making a difference for their patients by investing in better quality, better value, and better-designed services.'

Health Committee