How much do we know?
All primary care trusts (PCTs) should be asking questions about what they get for their money. Some questions can now more easily be answered than others. Since 2003/04, programme budget information has been compiled by all PCTs, showing how much each spends on a complete list of 23 broad disease categories.
PCTs can now benchmark their spending with each other. The first step is to look at the variation in spend - and there is clearly considerable variation.
Take respiratory disease, for example. Spending apparently varies from less than £45 per head of population to more than £120. Taking account of a population's age, sex and deprivation closes the gap only partially (range £49 to £118). The next stage for the PCT is to try to explain the variation and account for its own position.
Clearly, services cost more to provide in some areas of the country than in others. So adjustments for market forces need to be done, although they explain hardly any of the overall variation.
Clearly the main reason for any such variation ought to be variation from PCT to PCT in the number of people suffering from the disease. So this is the next stage in the process.
Using information from GPs on numbers of patients with chronic obstructive pulmonary disease (COPD) as a proxy for overall prevalence of respiratory disease, PCTs with more COPD patients do tend to spend more. This explains about half (46 per cent) of the observed variation and each PCT can measure where it stands.
A further explanation may be poor quality data. So it is important for PCTs to address this. And the Audit Commission has recommended that the programme budget data be audited. It seems unlikely, though, that poor quality data can be the only explanation. There may be others, including local prioritisation and history.
But to give a full answer to the original question, information on outcomes is needed. This is the real prize, and enables judgements to be made about a PCT's performance as a commissioner.
Similar information is available for each of the 23 disease groups. The findings are also similar, although some can be more extreme. This is a process which all PCTs should go through if they are to get best value out of the money available to them.