It seems the majority of GPs believe in practice-based commissioning, but there still remains significant doubt as to whether it has actually improved patient care, a survey by Ipsos Mori on behalf of the Department of Health has found.

The idea behind PBC, a key component of the government’s healthcare reforms under which primary care trusts are given their own budgets to make local decisions on what to commission, is that it 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,” the DH explains.

But, out of 1,198 practices that responded to the quarter’s survey, 57% supported PBC while just a small minority - 8% - strongly opposed it. Moreover, while 37% of respondents felt the flags were still out as to whether the policy has improved patient care, a substantial 13% insisted that it hadn’t.

Fifty-six percent of practices said they had received an indicative budget from their primary care trust, but most of these believe it has yet to make a difference to the way the GP practice operates, indicating that the effective implementation of PBC has not been as seamless as the government hoped.

A further illustration of this is the survey’s finding that less than half of practices had agreed a commissioning plan with their PCT, and over half of respondents said they weren’t getting enough support from their PCT, with 26% even going so far as to state that managerial support was “very poor”.

Gap between perception and practice

According to the NHS Alliance, the survey reveals a worrying gap between practice and PCT perceptions. It points out that, while a third of practices say they still do not have an indicative PBC budget, according to PCT returns, virtually all have been given their budget. And although 72% of practices say they have a good relationship with their PCT, more than half say management support and information is poor.

The NHS Alliance PBC Federation, which works directly with practices, PBC groups and PCTs across the country, claims that the essential ingredients for effective PBC are always the same: good relationships between the practices and the PCT combined with strong management support providing good quality financial and activity information. However, it stressed, a negative culture and confusing information will give rise to poor results follow.

“A small number of PCTs may have been reluctant to get behind PBC. The Alliance is confident that will change. Similarly, some GP practices are slow to get engaged. Addressing these issues needs more detail than is provided in the national survey,” it said.

And NHS Alliance PBC lead Dr David Jenner added: “There is wide agreement that we have the right policy – and there are areas where it is already working well. Yet, in other places, PCTs and SHAs [Strategic Health Authorities] are in denial over real problems with implementation.” He warned that, if they “continue to maintain the mistaken belief that all is well, PBC will fall apart”.

“Practice based commissioning must be made a headline priority…We are looking at a moving picture and are confident of seeing improvement in the next quarter’s results,” he concluded.

King's Fund report

To some extent, the findings echo those of a report by the King's Fund earlier this year. Of more than 250 GPs and general practice managers taking part in the survey, 73% said they were “firmly committed” to PBC, but several factors getting in the way of implementing the system effectively were also identified.

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 2008.