Practice based commissioning: give GPs control or risk world class status

In a document published last week as part of the Department of Health’s plan to ‘reinvigorate’ GP commissioning, it was revealed that PCTs would not be allowed to reach level two in world class commissioning’s clinical engagement competency next year without having proved that ‘strong clinical involvement and support for practice based commissioning’ exists in their area.

They will also be held back if they fail to provide information and support on finance and management, do not provide GPs with indicative budgets by 1 May or do not agree local practice based commissioning incentive schemes.

National clinical director for primary care David Colin-Thomé said PCTs could be held to account using the poll which the DH runs to gauge GPs’ views about progress in the scheme.

Poll results will also be used to focus strategic health authority level discussions about the progress of practice based commissioning as Dr Colin-Thomé and his team embark on visits to every region to drive GP commissioning.

He said the DH wanted to see more than “sporadic bits of good work”.

Clinician involvement

“We want to have this much more mainstream - we want clinicians much more actively involved,” he said.

GPs will be expected to advise PCTs on clinical issues affecting commissioning and consider commissioning issues from the perspective of practice populations, as well as commissioning care for individual patients.

In return, Dr Colin-Thomé said GPs would eventually be allowed to take control of some actual budgets, but they would have to “earn” this freedom by proving they had the skills to use budgets, work in partnership with PCTs and consider “broader determinants of health”.

Practice based commissioning has proved slow to get off the ground, with a King’s Fund report last year finding it had made little impact so far.

The HSJ Commissioning Challenge is on 24-25 March, www.hsj.co.uk/conferences