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GPs' reforms questioned

22/11/2007

A drive to give GPs greater financial control and responsibility for their services has made limited progress since it began, a report has concluded.

The Audit Commission said that practice-based commissioning (PBC) will not be successful until the right financial infrastructure is in place.

It found that few areas of GPs' care were carrying out practices that are central to success.

PBC was introduced in 2005/6 with the aim of giving GP practices and primary care professionals the resources and freedom to develop new local services and more choice for patients.

The Audit Commission, an independent body that monitors how public money is spent, studied commissioning arrangements, policy and implementation in 16 primary care trusts (PCTs) and reviewed findings from local audit work of PCTs and acute trusts in England.

It concluded that for PBC to be successful there should be timely provision of robust budgets; regular, accurate and easily understood information; freedom for practices to make changes; sound governance plans; and greater shared ownership between PCTs and practices on how resources should be used to support strategic objectives.

But these are not being implemented across the board, the Audit Commission concluded, and many areas were found to have been hampered by reorganisation.

Where success has been achieved it was largely the result of a small number of enthusiastic practices working closely with supportive PCTs who recognised the commitment involved, the study said.

Audit Commission chief executive Steve Bundred said patients are "losing out" as PBC is not yet producing the service improvements it can provide.

"PBC offers potential benefits to patients but won't take off unless the NHS gets the financial infrastructure right," he added.

"Clear and sustained leadership for this policy is also needed if it is to deliver."

Dr Laurence Buckman, chairman of the British Medical Association's (BMA) GP committee, said the Audit Commission's report "highlights what many GPs have unfortunately known for quite a while".

"PBC has great potential but that potential will never be reached if PCTs continue to block initiatives and fail to support practices adequately," he added.

In response to the report, David Stout, director of the PCT Network which represents the majority of PCTs, said: "PCTs are currently involved in an ambitious programme of improvement through world class commissioning, of which PBC is an integral part.

"It should be seen in the context of PCTs' wider commissioning role, and is not just about financial management. As the report suggests, robust budgets, accessible information and sound governance will of course help ensure the success of PBC."