Government accused of ‘fiddling the books’
pharmafile | December 21, 2006 | News story | |Â Â Â
A leading GP has accused the government of fiddling the books on the uptake of practice-based commissioning.
Dr David Jenner, the NHS Alliance national leader for PBC, believes government assurances that there is now an almost 100% take-up of PBC are, at the very least, misleading.
He said: "According to the Department of Health, 82% of practices are signed up to PBC. Its true that 82% are receiving the direct enhanced payment (95p per patient), but all that means is that they have agreed to put forward a plan – not that they are actively commissioning."
Dr Jenner maintained: "You could say the government is fiddling the books to make the concept of PBC appear more successful than it actually is."
He claimed that cash-stricken primary care trusts were withholding PBC budgets from GP practices by using the excuse that plans were not robust enough.
Some practices were now only signing up to qualify for the 95p per patient direct enhancement payment – designed to encourage them to adopt PBC – and not submitting commissioning plans at all, he said.
Dr Jenner added: "Many PCTs and practices still do not have reliable data to formulate plans. Budgets are therefore often based on dubious information."
Jo Webber, deputy policy director of the NHS Confederation, admitted that signing up to PBC was not the same as actual commissioning and said it was still early days to be certain of how many practices were actively engaged in the process.
She agreed that there was much work to be done in building effective communication networks between PCTs and practices. "Lines of communication are still weak in many places," she explained. "The fundamental re-organisation of PCTs and SHAs in October means that new relationships between them and their practices are still being forged."
Webber commented that PCTs, under enormous pressure to balance their books, would be very carefully scrutinising plans submitted by GP practices. She added: "They are going to be very cautious about risk factors, which is why it is imperative that doctors and primary care trusts must work together to produce strong, mutually-agreed plans for PBC. The reform agenda is so big that it will not work if we do not pull together."
The concept of practice-based commissioning was first launched in July 2005, as part of the government's publication Commissioning a Patient-led NHS.
Dr Jenner stressed: "We need better evidence that services have been delivered before paying the bills. We need better evidence about quality – comparative data is essential. And we need better evidence of outcomes and patient satisfaction included in contracts."
He added: "The public expects and needs that level of transparency – and good commissioning depends on it."
