Published: 01/12/2005 Volume 115 No. 5984 Page 25

Practice-based commissioning is here - but will it prove effective?

This was the question explored at two simulations hosted by Havering and Waltham Forest primary care trusts, which brought together nearly 100 participants from the PCTs and acute trusts as well as GPs, practice managers, nurses and others.

A facilitated set of conversations between participants working in their real life roles explored how they would handle a set of realistic local challenges.

Participants also had the chance to work on a sample commissioning plan which addressed their practice priorities.

The simulations showed that although PCTs had prepared for practice-based commissioning, understanding how practices would react was invaluable to demonstrate the need for clear rules.

What has changed since the fundholding era is that practices have a greater recognition of the importance of partnership in delivering change. The days of the isolated practice are over.

Whether practicebased commissioning can deliver on expectations seems to rest on two key developments.

Practices themselves need to form networks to replace PCTs' collective commissioning. It cannot be a PCT-imposed solution.

Second, commissioning will continue to need some sophisticated ringholding by the PCT - setting a service strategy for the health and social care economy that is clear enough to inform practice-based commissioning and sufficiently flexible to incentivise innovation.

Further messages for PCTs implementing practice-based commissioning were:

Ensure you provide practices or clusters of practices with sound quantitative and qualitative evidence about health needs and service activity.

Clarify what support practices can expect.

Support practices in developing links with each other.

Keep a watching brief on the leadership of practice-based commissioning within any clusters, and how it is done and rewarded.

Provide early details about the incentive scheme for savings.

Work with practices to clarify how they will tackle the full range of commissioning tasks.

Focus practices on quick wins to gain their commitment and provide advice and support on change-management methods.

Clarify how practices can influence commissioning for children's services, mental health and care for older people if they are not to be given direct commissioning responsibilities for these services.

The key element in all this is a common interest in what makes sense for patients. Practice-based commissioning is a means to an end, not an end in itself. Keeping focused on service benefits and health improvement provides a common agenda.

Kevin Mullins is practicebased commissioning project director for North East London strategic health authority and Sarah Harvey is acting director of health and social care for OPM.