Practice-based commissioning is here to stay, Peter Dunkley, Head of Healthcare Development and Strategic planning at a big pharma, told

delegates at the EyeforPharma conference in London this week.

PBC is one the government’s flagship health policy reforms, now in its third year, under which practices have a budget to commission their own services, the idea being that this will deliver higher quality care to local communities.

The reality, however, remains somewhat murky. Recent surveys by the Department of Health suggest that less than 20% of practices have a usable commissioning budget, Dunkley stressed, and there is low understanding at the Primary Care Trust level.

Earlier this year, a survey of more than 250 GPs and general practice

managers conducted by The King’s Fund and NHS Alliance found that,

although 73% said they were “firmly committed” to the policy, several

factors are getting in the way of implementing the system effectively.

Lack of support

Thirty-nine per cent reported a lack of support from their primary care

trust, while 23% believed financial constraints and short-term thinking

were barriers. Excessive bureaucracy, national targets and structural

reorganisations were also flagged as major problems. Consequently, 53% of

respondents felt that PBC had failed to improve the quality of patient

care but, equally, more than half were optimistic about improvements in


The National Health Service has been through years of change and reform,

and financial responsibility has been shifted around from group to group,

with devolution now resting at the bottom of the chain with GPs and

nurses. Although there is an understandable lack of confidence that PBC is

here to stay, Dunkley maintains it is highly unlikely that there will be

another turnaround back up the chain now.

And Dr James Kingland, chairman of the National Association of Primary

Care, agrees: “The traditional model of block contracting is unsustainable

and leads to uncontrolled spend,” he said, adding: “There is no ‘plan b’,

[PBC] is still the keystone of NHS reform.”

Furthermore, under the government’s mantra of boosting patient choice andimproving accessibility, the introduction of alternative provider medical

services has seen the selling of practices into commercial hands, Dunkley said. “How many businesses can you buy with a guaranteed

revenue stream of £1 million?” he asked. Private groups are making these businesses more efficient and so successful that if PCTs did ultimately wish to buy back APMS, it is unlikely that they would be able to afford it, he explained.

Moving targets

In terms of what PBC means for the pharmaceutical industry, Dunkley

insists that, although PCTs are still re-organising and pharma is unsure

of who the customer is, “this is a tremendously exciting time in the NHS

and the opportunities are huge.”

“It’s our responsibility to make the industry look as professional and

knowledgeable up as possible,” he said, and stressed that, with regard to sales targets and strategies, one size no longer fits all, you must understand the specific needs of each locality.