ractice-based commissioning has taken another beating in a new report claiming the flagship reform policy is simply not working in its current state and that the purse strings should truly be handed to local clinicians instead.

A key component of the government’s healthcare reform agenda, PBC was rolled out to much fanfare back in 2005 with the promise that, by handing primary care trusts control over their own budgets to make local decisions on what services to commission, the scheme would encourage better clinical engagement, more efficient use of resources and provide a better, more tailored service for patients.

But the uptake of PBC has been much slower than anticipated, and 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.

And now, a new report by The NHS Alliance and health research charity The Nuffield Trust has also claimed that the policy is failing to deliver on its objectives. Beyond Practice-Based Commissioning: the local clinical partnership claims that “practice-based commissioning has struggled to deliver better services for patients or financial savings since it was introduced”, and it calls on the government to consider “radical alternatives” to help bring about real service improvements.

Dr Judith Smith, Head of Policy at the Nuffield Trust and lead author of the report, says the health service is currently facing “the greatest financial and leadership challenge it has encountered in a generation”, and that “radical action” is necessary if clinicians are to play a key role in designing services during this uncertain period. “PBC has shown patches of promise but we need a more far-reaching alternative that re-engages GPs and other clinicians in this agenda,” she stressed.

The alternative put forward by the report proposes bringing together hospital and community-based clinicians to create new organisations that hold responsibility for health outcomes in local communities. “They would form Local Clinical Partnerships and be handed real budgets to design, deliver and commission local health services,” it suggests, insisting that this would re-engage clinicians in “reform and delivering a health service that is affordable, centred on the needs of patients and led by clinicians”.

More for less?
Explaining the strategy, Julie Wood, Director of PBC at the NHS Alliance and one of the co-authors of the report, said: “We need to build up on what has worked in PBC and this report shows that encouraging clinicians to form their own organisations, with fully devolved responsibility for ‘make or buy’ decisions, will allow the NHS to provide better health services for less”.

If Local Clinical Partnerships are to succeed, however, the report says clinicians must be given real budgets in return for responsibility and, just as importantly, accountability for health outcomes, patient experience and financial performance. In addition, appropriate incentives must be put in place to promote a close relationship between the new organisations and GPs, which is “vital given GPs’ general disenchantment with PBC”, it points out.