Audit Commission

The government's drive to give GPs greater financial control and responsibility over the services they commission for patients is making limited progress, according to a report published by the Audit Commission today (22 November).

Practice based commissioning, which was introduced in 2005/06, is one of the main policies in the government's programme to reform the NHS. It aims to give GP practices and primary care professionals the resources and freedom to develop new local services and more choice for patients.

The Audit Commission looked at how the financial management arrangements supporting practice based commissioning are working, the incentives for GP practices to engage with it and the obstacles to its introduction.

Steve Bundred, Chief Executive of the Audit Commission, said:
'Practice based commissioning offers potential benefits to patients but won't take off unless the NHS gets the financial infrastructure right. Clear and sustained leadership for this policy is also needed if it is to deliver. At the moment patients are losing out because they are not benefiting from the service improvements which practice based commissioning can provide. Our recommendations are designed to help the Department, PCTs and practices achieve that potential.'

The report found that the factors central to success were:

• timely provision of robust budgets which were well understood and accepted by the GP practices which would commission services;
• regular, accurate and easily understood information which enabled GPs to monitor progress;
• freedom and support for practices to make changes and to generate and use savings for the benefit of their patients;
• sound governance arrangements for approving business plans and overcoming any potential conflicts of interest when practices use their commissioning budgets to purchase services from themselves; and
• greater shared ownership between PCTs and practices on how resources should be used to support strategic objectives.

Few areas had all these factors in place. Many had been hampered by reorganisation. Where there had been some success, it was largely the result of a small number of enthusiastic practices working closely with supportive PCTs who recognised the commitment involved. In these places, practice based commissioning was starting to have an impact on managing referrals as GPs understand the financial consequences of the clinical decisions they make.

Notes to editors

1. Interviews were conducted at 16 PCTs and 3 GPs at each of the 16 PCTs to examine local commissioning arrangements, identify obstacles to implementation and to collect notable practice; a survey of 122 GPs and practice managers to get a practice perspective on policy and implementation; and a review of findings from local audit work of PCTs and acute trusts in England.
2. The Commission audits NHS trusts, PCTs and strategic health authorities to review the quality of their financial systems and works with foundation trusts.
3. The Audit Commission is an independent body responsible for ensuring that public money is spent economically, efficiently and effectively, to achieve high-quality local services for the public. Our remit covers around 11,000 bodies in England, which between them spend more than £180 billion of public money each year. Our work covers local government, health, housing, community safety and fire and rescue services.
4. Further details about the role of the Audit Commission can be obtained from www.audit-commission.gov.uk.