Mending NHS Commissioning, UK

Main Category: Public Health
Article Date: 20 Nov 2008 - 8:00 PDT

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It is government policy to put clinicians and clinical judgement back at the heart of NHS decision making. That is the concept behind Practice Based Commissioning (PBC). The idea is to devolve power to GPs to commission the services their patients need.

Yet the system seems unable to support PBC, as the thorough study published today by the King's Fund demonstrates. Their findings from an in-depth examination of four PCT areas exactly echo the NHS Alliance's nationwide information on progress.

The King's Fund is right to say government must give higher priority to PBC. At the same time, guidance should be rigorously enforced and strategic health authorities charged to ensure it is followed.

There is also a need for lateral thinking - and to give PBC real teeth so that commissioners, whether in practices or PCTs, can make sure hospitals and other providers are delivering what is needed.

That could be achieved very simply. There is already a mandatory requirement for discharge letters to be provided to GPs within 72 hours of each patient's discharge from hospital. It would be straightforward to include relevant financial information in these and the similar reports from outpatient appointments. The discharge letter would, in essence, become the invoice. The coding system already in use defines what investigations and treatment the patient has received. By including that with discharge information, practices could easily check its accuracy, helping their PCTs to approve payment and solving the problems caused by inadequate management information. If the letter is late or inaccurate, payment would be delayed.

NHS Alliance chairman Dr Michael Dixon said:

"There should be no excuse for failing to provide budgets and accurate financial information to practice based commissioners. Yet that is exactly what has been happening. It is often not the fault of PCTs but of the system above them.

"The King's Fund is right to say that urgent action is necessary to overhaul PBC. But that action need not be complex or costly. The simple solution we have proposed would transform commissioning by putting the power where it should lie - with the commissioners instead of, as at present, with the acute sector.

"If providers find they do not get paid unless they do the job properly, that would sharpen everyone's performance. And it would also enable practices and PCT commissioners to become fully engaged in NHS decision making."

Notes

1. The NHS Alliance is a collaboration of clinicians, managers and board members who put patients first. It is the independent body that represents NHS primary care. Values based, it is the only organisation that brings together PCTs with GP practices, clinicians with managers and Board members, and NHS primary care with its patients. The Alliance membership and its hard working national executive is fully multi-professional.

2. Practice based commissioning: reinvigorate, replace or abandon is published today by the King's Fund.

3. The recent Wave 4 PBC survey, carried out for the Department of Health by IPSOS MORI and published August 2008, found that 59% of practices said they had received their PBC indicative budget, while 27% said they had not. 13% did not know. Practices that have not received their budget are constrained from implementing PBC.

NHS Alliance

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