The government’s primary care tsar has admitted that efforts to “resuscitate” the “corpse” of practice based commissioning have had little effect.

National clinical director for primary care David Colin-Thomé said last week that the Department of Health is “hard at work trying to reinvigorate” practice based commissioning but said it “isn’t really taking off, in any systematic way”.

I think the corpse is not for resuscitation. There doesn’t seem to be much traction

He told delegates at the Wellards annual conference in London that it was hard to say why this was. “But it’s certainly not seen as a major vehicle for change,” he said.

The DH published extra guidance in March intended to mark the start of a new push to get practice based commissioning “working to its full potential” – five years after the policy was first launched. 

The document, Clinical Commissioning: our vision for practice based commissioning, included various ideas intended to try to “reinvigorate” the stalled policy.

It set out entitlements that commissioners could expect, including that primary care trusts should make decisions on practice plans and business cases within a maximum of eight weeks, and that PCTs would be held to account for the quality of their support.

Dr Colin-Thomé said: “We thought we’d try and reinvigorate it, and we had all sorts of ways of doing it – entitlements and things like that.

“But I think the corpse is not for resuscitation. There doesn’t seem to be much traction,” he said.

“We’re struggling to make it systematic,” he added. “There’s a lot of support around it but it’s not really taking off out there.”

However, Dr Colin-Thomé insisted that clinicians do need to have some form of budgetary responsibility in order to “reshape how clinical care is provided and challenge inappropriate and ineffective interventions”. “Clinicians, doctors especially, we spend the money,” he said.

The apparent failure of practice based commissioning has not deterred the Conservative Party from sticking to its policy of giving GPs “real” budgets if they win the election.

Writing in HSJ earlier this month, shadow health secretary Andrew Lansley said: “We will hand them real budgets to manage the costs of their patients’ care. They will have a direct incentive to buy the most efficient services on behalf of their patients, because they will be able to keep any savings and use them to reinvest in care.”

Speaking at the Wellards conference last week, NHS Confederation director of policy Nigel Edwards said the Conservatives were “basically betting the ranch on hard budgets for GPs as a mechanism for change”.

“I’m torn on this,” he told delegates. “There are some big questions.”

Mr Edwards said he would have no concerns about GPs he had met who already do practice based commissioning and “do this well”. But he said: “There are some really interesting questions about what to do with the people who don’t want to do it or don’t have the skills or the capacity.”

He added: “The other issue of course is that GPs are also providers. If you want to bring new providers in, which is also part of Conservative policy, then it’s quite hard to do that if the commissioner is one of your potential competitors.”

Birmingham East and North PCT chief operating officer Andrew Donald said: “I tend to agree with the principle of giving GPs hard budgets because actually they are the ones who create most of the cost. They write referrals, they write prescriptions, their patients got to A&E, their patients have emergency admissions.”

GP commissioning is turning in its grave