The Department of Health’s head of urgent care told a conference that GP practice-based commissioning needs a “relaunch” to “redefine and reinvigorate” its central role in NHS commissioning. Chris Dowse, Head of Urgent Care at the Department of Health, told the NHS Alliance conference Urgent care at the crossroads: chaos or creativity? that the Department’s view remains that practice-based commissioning (PBC) is “here to stay .. the question is how to relaunch it”.

Commissioning is the analysis of local health needs and the procurement of health services to meet those needs. Primary care trusts (PCTs) are responsible for commissioning and providing a range of community services (although their involvement in provision is being phased out). Policy intends that PCTs should provide groups (called consortia) of GP practice-based commissioners with data on hospital resource use and indicative budgets, against whioch they can make savings on ‘freed-up resources’ by providing services more cheaply than the NHS tariff price in the community.

Practice-based commissioning (PBC) has been stymied in many areas by late or inadequate provision of budgets and data, and a lack of available management support from the PCT to assist GP practices in using the data to review existing services and consider changes in provision.

Welcome candour
These candid remarks will be welcomed by those who support the fundamental idea of commissioning as the best approach to align resource use decisions as close to the front line of care as possible. The Department of Health’s ‘world-class commissioning’ programme has almost entirely focused on PCTs’ commissioning progress, and a new assurance system for PCT commissioning runs its first national programme over the next few months.

Dowse noted that “clinical engagement is key to world-class commissioning, and practice-based commissioning (PBC) can be a strong vehicle, … but it’s fraught with difficulties, and one size does not fit all.

Admitting that PCTs are “in very different places” with their attitudes towards PBC, she noted that the Department of Health are “rethinking PBC, but only to redefine and reinvigorate it. PBC here to stay; the question is how to relaunch it."