The majority of general practitioners believe in the potential of practice-based commissioning but, according to the results of a new survey by the King’s Fund and NHS Alliance, there are still several barriers holding back its success.

Of more than 250 GPs and general practice managers taking part in the survey, 73% said they were “firmly committed” to the policy, 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.

A learning curve

Commenting on the findings, David Stout, Director of the NHS Confederation's PCT Network, which represents primary care trusts in England, said: "PCTs are working hard to support GP practices,” but he went on to point out that "the development of practice-based commissioning is a learning process that will take some time and effort to get right."

The findings are published in a joint King’s Fund and NHS Alliance report, Practice-based Commissioning: From good idea to effective practice, which says that, while there are reasons to be optimistic that PBC will deliver benefits such as lower rates of hospital admission and a cut in prescribing costs, there are a number of “practical challenges” to overcome first.

PBC is one the government’s flagship health policy reforms, under which practices have a budget to commission their own services, the idea being that this will deliver higher quality care to local communities. But, the report warns, it may fail to make any improvements unless primary care workers get much better support from PCTs.