The government yesterday unveiled a new vision for practice-based commissioning to rejuvenate the stagnant reform policy and encourage its infiltration of the healthcare system.

PBC is a flagship component of the government’s healthcare reforms under which primary care trusts are given their own budgets to make local decisions on which services to commission, in the hope that this will foster better clinical engagement, provide a better service for patients and encourage better use of resources.

“By giving practices the ability to develop new services for patients within a framework of accountability and support, PBC will improve access, extend patient choice and help restore financial balance,” according to the Department of Health.

But since its launch the initiative has been hit with opposition and criticism. Its implementation has been much slower than originally envisaged by the government, and many believe that its potential is not being realised, despite the fact that GP support for PBC remains high at 62%, with a further 20% staying neutral, according to the last quarterly survey in December.

Late last year a report from think-tank The King's Fund warned that PBC is still failing to deliver and that progress has been slow. The report, Practice-based commissioning – reinvigorate, replace or abandon?, claimed that “very few PBC-led initiatives have been established and there seems to have been little impact in terms of better services for patients or more efficient use of resources”.

Unwavering commitment
But while the government’s new vision - developed in collaboration with a broad range of clinicians, PCTs and Strategic Health Authorities - admits the failings of the policy to date, it confirms its commitment to the initiative and sets forth a series of measures designed to help embed PBC into health service culture once and for all.

For example, one of the key barriers to the success of PBC has been a reported lack of information and support from primary care trusts and, to address this, 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, “with ultimate recourse to the SHA if this is not delivered”, the report stresses. They are also required to agree PBC incentive schemes to help promote better health and better value, it says.

According to health minister Lord Ara Darzi, the new vision “goes a long way to set out the roles of practice based commissioners and what they should expect in return,” and he stressed that “successful [PBC] will be characterised by clinicians, including GPs, community nurses, allied health professionals, pharmacists and secondary care clinicians engaging in the continuous cycle of reviewing the needs of their community, how resources are used and the services delivered for patients”.

PBC development scheme underway
Meanwhile, the first project to support the development of PBC – as per the government’s evelopment framework announced last year - has begun with NHS Brent PCT.

The PCT will be working with a partnership of Humana Europe and the NHS Alliance, with support from Dr Foster Intelligence, to help develop the skills of doctors and managers and boost the capacity of PBC.

“This is fantastic news, and means we can now start working in earnest with the local health community across Brent to really support them to take full advantage of PBC for their population,” commented Julie Wood, NHS Alliance National PBC Federation Director.

The Department of Health established a PBC Development Framework in December last year to provide “a structured and time efficient method for NHS bodies to rapidly procure high quality support to boost their PBC capability and skills”.

A total of five organisations (and their partners) have been appointed to the PBC Development Framework to support the capability development of PCTs and PBCs.