Practice-based commissioning (PbC) has been a cornerstone of the government’s health service reforms in England since it was introduced in 2005, but it has so far had limited success. With the future of PbC in the balance, this joint paper by the Nuffield Trust and the NHS Alliance examines how PbC can be developed.
With the NHS about to enter a period in which growth in its budget will be severely constrained, it is vital that clinicians, especially doctors, are engaged in decisions about how patient services are designed and delivered and how NHS money is spent. While there may be many ways this could happen, this paper considers one broad model – that of multi-specialty groups of clinicians – for example GPs as well as hospital-based specialists – taking responsibility for the provision and commissioning of local health care.
A ‘local clinical partnership’ (LCP), with full responsibility for a population’s health outcomes and funding, is examined as a means of bringing together the known benefits of involving clinicians in NHS resource management, with an incentive structure that could engage them in local service redesign. Its aim would be to improve quality of care and secure greater efficiency of service provision. LCPs would be handed real budgets and would have responsibility for the health outcomes of their local communities. The paper proposes that this model holds real promise as a way of developing more efficient and higher-quality care beyond PbC.
The report proposes a model that holds real promise as a way of developing more efficient and higher-quality care
This paper has been informed by a series of interviews and two workshops held with clinicians and managers active within PbC, academics, and policy-makers expert in this area. In these interviews, people were asked about their views of the role and potential for groups of clinicians to assume responsibility for health provision and commissioning in the NHS. As context to the study, a review of the research and policy literature on physician groups, multi-specialty groups and primary care organisations was undertaken, including material from the UK, USA, Australia and New Zealand.
Beyond Practice-based Commissioning: the local clinical partnership, will be important reading for health care leaders, policy-makers, practitioners and academics interested in this crucial area of health care reform.