News / Infrastructure key to PBC success

The Commission examined how well the financial management arrangements that support practice-based commissioning (PBC) were working, the incentives for GP practices to engage with it and the obstacles to its introduction. It found a number of factors were needed for success but few areas had them all in place.

Audit Commission chief executive Steve Bundred said the initiative has made limited progress. ‘Practice based commissioning offers potential benefits to patients but won’t take off unless the NHS gets the financial infrastructure right. Clear and sustained leadership is also needed if it is to deliver. At the moment patients are losing out because they are not benefiting from the service improvements PBC can provide.’

The auditors interviewed GPs in 16 primary care trusts and concluded the necessary financial infrastructure included: timely provision of robust budgets that were understood and accepted by the GP practices; freedom and support for practices to make changes and to generate and use savings for the benefit of their patients; sound governance arrangements for approving business plans and to overcome potential conflicts of interest when practices purchase services from themselves.

Few PCTs had all factors in place, many because they had been concentrating on reorganisation. Successes had been down to enthusiastic practices working with supportive PCTs. Here PBC was beginning to make an impact on managing referrals.