Editor’s blog Wednesday 30 June 2010: DH survey shows PBC ineffective and in retreat

We don’t even know yet what GP-led commissioning is going to be called.

It might be called  ‘clinical commissioning’. It might be called ‘Eric’.

We do know that it is not going to be called GP practice-based commissioning (PBC), and on the evidence of the new DH Year Three survey on PBC, that is A Good Thing.

It tells us little we didn’t already know about the policy – basically, where PCTs and GPs are engaged locally, PBC has done good things. Which has been in far, far too few places.

'37% of respondents still do not regard their PCT’s management support for PBC as good'

The survey (with a by-no-means-bad response rate of 61%) also tells us wildly unimpressive things about PCTs’ ability to recognise that commissioning was going to be part of the future. Three years since this survey began, 37% of respondents still do not regard their PCT’s management support for PBC as good.

An impressive 71% of respondents regard their PCT’s speed of decision-making over submitted business cases as not good. (With touching pathos, the press release trumpets a 4% increase in those who do regard PCT decision-making speed as good over the survey’s three years. It would take a heart of stone not to laugh.)

'71% of respondents regard their PCT’s speed of decision-making over submitted business cases as not good'

Just an indicative budget, ma’am
Given the current shenanigans and Treasury tremors over devolving virtually all the NHS’s £105 billion budget to GP commissioners, we can only chuckle that PCTs who offer their GP consortia even indicative budgets (i.e. not real money) continues to decline.

73% of respondents report receiving a PBC budget from their PCT (compared to 80% in Wave 2 and 84% in Wave 1). 71% have agreed a PBC commissioning plan with their PCT; also significantly lower than the Wave 1 and Wave 2 scores 80% and 76%, respectively. The press release suggests that “the decline in these scores is likely to relate to the timing of the survey at the beginning of the financial year”.

Eine kleine business involvement
90% of respondents report that they have ‘at least a little involvement’ in addressing variation in primary care use of resources or referrals.

The unsurprising corrolary is that the 75% of respondents who have submitted ‘at least some’ business cases or service redesign plans to their PCT this financial year represents another significant reduction, compared with Wave 2 (83%) and Wave 1 (81%).

PBC has made no difference to clinical practice for 41%
41% of respondents indicated that PBC has not influenced (i.e. neither ‘a great deal’ nor ‘a fair amount’) the clinical practice of the GP practices within their group.

Oh dear. Oh dear. Oh dear.