Primary care commissioning may well have been “the slow train to Calcutta”, but there have been numerous obstacles preventing the policy from reaching its potential, says Michael Dixon, NHS Alliance chairman.

His comments are in response to a report by the Health Committee last week that criticised primary care trusts for failing to commission effectively.

According to the Committee, PCTs lack the drive – and the clinical knowledge - to challenge hospitals over services provision, and it says “constant reorganisations and high turnover of staff have made a bad situation worse”.

In a major blow to the government’s flagship ‘World Class Commissioning’ initiative, the Commission has questioned whether it will lead to the necessary transformation of trusts, and warns the commissioning system “may need to be scrapped altogether if reliable figures reveal an uneconomic policy which is failing to reap the desired benefits”.

“It is a sorry story if, after 20 years of attempting to operate commissioning, we remain in the dark about what good it has actually done,” said Kevin Barron, Committee Chair. “The government must make a bold decision: if improvements fail to materialise, it could be time to blow the final whistle”, he stressed.

But in defence of the ailing policy, Dixon says commissioning success “is crucial if we are to move from a provider driven NHS to one that meets the needs of its patients and makes best use of money in a cash-strapped NHS”.

He also lays part of the blame for its current failings on continuous PCT reorganisation/disorganisation, claiming that commissioners have found it difficult to “get their feet under the table” as a result.

In addition, the NHS Alliance argues that the NHS is still “too secondary care centric and centrally driven, for example through targets, NICE guidelines and ‘DH/SHA command and control’, to allow its primary care commissioners sufficient autonomy to do their job”.

But despite the obstacles in its path Dixon says there are many examples of where good commissioners are already making a substantial difference to services and local health, and primary care commissioners need to be given “a proper chance and the power, which they have largely not had so far”, to make the policy work to its best potential.

What's the alternative?
“The alternatives, an NHS that is centrally-directed – which we know it doesn’t work – or one that is left entirely to the competitive market, such as in the USA, are hardly more attractive,” he noted.

Steve Barnett, chief executive of the NHS Confederation, has also slammed the Commission’s findings, which he says do not “accurately reflect the improvements made to progress commissioning in recent years given the numerous examples submitted to the committee”.

“All healthcare systems need a commissioning function to operate effectively [and] we continue to believe that the current system designed to achieve value for money and hold provider organisations to account has been beneficial for NHS patients in England,” he stressed.

David Stout, director of the PCT Network, was also critical, noting that the “report does not offer a recommendation on how best to improve commissioning functions yet it suggests a fundamental restructuring of the NHS which would be counter-productive and fail to address the committee’s specific concerns”.