David Colin-Thomé on practice based commissioning

Practice based commissioning is very much here to stay and remains a key plank of the Department of Health’s primary and community care policy. Indeed, health minister Mike O’Brien said in a recent speech: “As the national director for primary care, Dr David Colin-Thomé has said of GPs and GP practices - ‘We spend most of the money, commit most of the resources, who best to challenge where clinical quality is poor and to always improve on the best.’

Aligning budgetary responsibility to the clinicians who commit the resources should be an important design principle for the whole NHS

“Now some of you may have read David’s reported description of practice based commissioning in last week’s HSJ as being like a ‘corpse’.

“Well, reports of its death have been greatly exaggerated!

“It is certainly true that it has not taken off everywhere, and we need to change that, but, and as indeed David Colin-Thomé actually said in his speech, where it has, the results have been truly impressive.”

Back to my thoughts - I am, as always, deeply committed to practice based commissioning. Aligning budgetary responsibility to the clinicians who commit the resources should be an important design principle for the whole NHS but only if those very same clinicians have the skills, aptitudes and capabilities to take on that responsibility. We need to find ways of involving clinicians who do not possess those attributes if we are to systematise practice based commissioning. When, as in primary care, that budget can be deployed to aid population health, the potential of practice based commissioning is even more enhanced.

I did use the words reported but went on to say - as was also reported - that there are many examples of excellent practice based commissioning implementation - so it is very much alive, well and kicking. If my words have confused or de-motivated the excellent, please accept my apologies.

But it is interesting to note that some GP leaders have welcomed my raising the profile by citing many examples where practice based commissioning has not ‘taken off’. Many PCTs and clinicians report an ever increasing involvement of clinicians in commissioning - which is excellent news, but many of the innovative and capable have not been offered devolved hard budgets. And that is the extra dimension that practice based commissioning offers and which is necessary if we are to deliver on the imperative of better quality, innovation, productivity and prevention. QIPP is our protection against a temptation to make arbitrary cuts when budgets appear to tighten.

To quote Mike O’Brien again: “Our challenge is how to achieve the vision of High Quality Care For All set out by Ara Darzi while finding new ways of releasing funds for frontline care from within existing budgets.

“Let me be clear, what I do not want to see are PCTs or trusts making their own, unprompted slash and burn hacks at budgets, second guessing the chancellor or the outcome of the general election and making drastic cuts.

“This simplistic, knee-jerk reaction will only undermine the incredible progress that a decade of investment has made and will only take us further from realising our collective vision for the health service.”

It is my belief that practice based commissioning is the vehicle most suited to achieving this vision. And I would add that implementation must be faster, more comprehensive and devolving if we are to succeed.