ractice-based commissioning is making a real difference to healthcare and is improving the patient experience, according to the majority of commissioners taking part in a government survey.

The quarterly survey, which is designed to track the progress of the scheme, found that 80% of practice-based commissioners believe that it is “showing some impact to their patients to bring about improvements in local health” and has had some impact in bringing care closer to home.

In addition, 77% said that their work in commissioning has helped make care more cost effective, which is vital given that the National Health Service is facing tough times ahead as the effects of budget constraints are magnified by rising demand on services and resources.

Huge strides have also seem to have been made in the relationship between commissioners and primary care trusts, with: 80% of practices having agreed a commissioning plan with their PCT compared to 64% for the previous quarter; 82% describing a good relationship with the PCT versus 60% in the prior survey; and 84% of commissioning groups and independent practices reporting having received an indicative budget compared with 61% during July to September.

However, the results may, to some degree, have been skewed by a change in survey responders, as the Department of Health is now directing its questions at commissioners themselves as opposed to a random selection of GP practices, to give a clearer picture of the impact of PBC and the level of PCT support.

“The new survey helps create a more accurate and robust picture of PBC both locally and nationally, highlighting areas which are doing an impressive job in making an impact to their patients, and identifying areas where this best practice needs to be spread to,” explained Health Minister Mike O’Brien, and he said the results “show that an ever growing number of practices are commissioning services to ensure they are continuously reviewing the needs of their patients and investing in better quality, better value, and better-designed health services”.

According to the government, PBC - whereby primary care trusts are handed their own budgets to make local decisions on what to services commission - is designed to encourage better clinical engagement and use of resources to ultimately provide a better, more tailored service for patients.

However, uptake of the policy has been much slower than envisaged, with large chunks of blame for its failings directed towards a lack of information and support from trusts to help set up the necessary infrastructure, an absence of adequate governance for any commissioning plans, excessive bureaucracy and national targets.

Progress slow
Just last month a new report by the NHS Alliance and health research charity The Nuffield Trust claimed that the policy is simply not working, and it called on the government to consider “radical alternatives” to help bring about real service improvements. The report proposed the formation of Local Clinical Partnerships – bringing together hospital and community-based clinicians – that will take over responsibility for health outcomes in local communities.

This followed a report in June a new report by Dr Jonathan Shapiro, a senior lecturer at the University of Birmingham Medical School, which claimed that PBC cannot succeed in its current state because fundamentally it is not in the interests of any the parties involved for it to succeed, as primary care trusts lose control and those commissioning services only gain bureaucracy.

But supporters of the scheme insist that it has a vital role to play in the reform of health services, and the government is working hard to breathe new life into PBC and cement its use in primary care via numerous measures, such as the introduction earlier this year of a new accountability process has been introduced under which trusts will be assessed on their commissioning skills and expected to reach certain targets.

In addition, trusts now have to provide every practice with an indicative budget and an agreed management and financial support package by May 1 every year, and are also required to agree PBC incentive schemes to help promote better health and better value, to ensure that the policy is better placed to reach its maximum potential.