| Practice based commissioning facing huge problems |
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| Written by Fred Hansen | |
| Sunday, 03 December 2006 | |
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By the end of this month, all general practices in England are
expected to commence practice-based commissioning (PBC), which involves
the purchase of hospital care and community services. However, GPs’
response to the government scheme has been lukewarm, because it is
perceived as over-bureaucratic. To some it appears that the main
purpose is to shift responsibility to GPs in times of a financial
crisis of NHS budgets. (Though GPs absorbed a huge amount of Gordon
Brown’s spending spree of the last four years, lifting the average GP
income from 55k in 2002 to 90k in 2006.) Others argue that PBC looks much like a return to the GP fundholding arrangements brought in by the Conservatives; that it does not solve any of the problems in that system; and so it will probably lead us back to the primary care groups model that was introduced to address those problems – another circle. Certainly, the additional administrative workload will be huge, and practices will have to employ new financial managers or retrain administrative staff. Practices will not necessarily have to commission/purchase all the services. Primary Care Trusts, which hold the actual money, can do this for them. But by the end of Year 3, GPs will eventually be responsible for the expenditure of the whole budget. Another issue could be missed appointments. The latest Developing Patient Partnership (DDP) survey shows DNA (did not attend) numbers have increased to eleven million for doctors and five million for nurses in the last year to July – up one million from previous year. This could have a knock-on effect for PBC. Since PBC will mean more expensive procedures happening in primary care, a correspondingly larger waste of resources would result from missed appointments.
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