Practice-based commissioning is being undermined by primary care trusts allocating funds to practices on a historical, rather than needs, basis, the Audit Commission has concluded.
Chief executive Steve Bundred told HSJ: 'Practice-based commissioning is proving slow to get off the ground. We've not yet seen any real evidence of it leading to the redesign and transformation of services in the way that was hoped.'
In Putting Commissioning Into Practice, published today, the commission highlights the reluctance of PCTs to change the way funds are allocated to practices.
'To change behaviours we need to see a much clearer and fairer system for allocating budgets,' Mr Bundred said. 'But in most of the places, the budgets which have been allocated to PBC practices reflect historic patterns of expenditure and in some instances there is a lack of clarity for the GPs about when they will get their budget and how it will be calculated.'
The lack of a fair allocation meant that GPs felt unable to change the way they spent money. That meant the shift in care services from acute to primary settings was being held up, said Mr Bundred. 'If you distribute money in the way it's been spent in the past, then people will just keep spending it in the way it's always been spent in the past.'
Mr Bundred acknowledged that PCTs had probably been trying to avoid the controversy that would come with changes in practice budgets. 'As soon as you make those adjustments you create winners and losers. The losers will cause you a lot of grief.
'Maybe PCTs will have to introduce it over a period of time. But we would like to see those changes take place more quickly.'