Things are looking very bleak indeed for the government’s flagship reform policy of practice-based commissioning (PBC), with recent remarks by the government’s primary care tzar David Colin-Thome suggesting that the scheme is dead in the water.

The national clinical director for primary care reportedly told delegates at the Wellard’s annual conference that the “corpse” of PBC is “not for resuscitation”, and while it is hard to pinpoint the exact reason uptake of the policy has not been what the government had hoped for.

“We’re struggling to make it systematic,” Colin-Thome admitted, and stressed that while there has been “a lot of support” for PBC “it’s not really taking off out there,” according to the Health Services Journal.

The government introduced its brainchild PBC five years ago as a major component of healthcare reform in the hope that, by giving practices the freedom to develop innovative, high-quality services, the scheme would encourage better clinical engagement and more locally-tailored services for patients, and thereby more efficient use of resources.

However, right from the start, uptake of PBC was slow and consequently failed to make any widespread impact on improving patient services or resource management. Moreover, various surveys undertaken since its introduction indicate that, while GP support for the principle seems high enough, several barriers are getting in the way of the policy reaching its full potential, such as a poor level of support from primary care trusts by failing to provide adequate information and timely indicative budgets.

In order to reignite enthusiasm over the stagnant policy, the government unveiled a new vision for PBC earlier this year which, amongst other things, included initiatives to ensure better support from PCTs, such as the introduction of a new accountability process under which trusts are assessed on their commissioning skills.

New vision failed?
The new vision sought to clearly set out the role of practice-based commissioners and what they should expect in return, but it seems that the government’s attempts to breathe new life into the ailing scheme have so far failed to make much of a difference.

However, doctors are still largely optimistic about the potential of PBC to improve patient care – a summer survey by think tank the King’s Fund and NHS Alliance of 320 GPs, practice and PBC managers showed that 78% were ‘firmly committed’ to the policy. And despite the failings of PBC, Colin-Thomé insisted that clinicians should have some degree of control over the purse strings in order to renovate and improve clinical care, reports the HSJ.