Key NHS reform 'delivered little'

GPs have been able to take charge of their own budgets since 2005

A key NHS reform aimed at developing more innovative community services has delivered little, says a report.

The King's Fund said family doctors in England had been slow to make the most of being put in charge of local budgets over the last three years.

The health think-tank said a "fundamental reassessment" of the policy was now needed.

Doctors said they wanted to make local budgets work, and the government said it would soon set out a new vision.

The policy is known as practice-based commissioning and involves GPs working in networks and taking on local health budgets from organisations called primary care trusts.

Now is the time for a fundamental reassessment of the policy Niall Dickson, of the King's Fund

The theory behind the move was that as "gatekeepers" to the NHS, family doctors would be more responsive to need and develop more innovative practices in the community.

But the King's Fund said progress had been slow so far and was now at risk of stalling.

It said some new services had been set up, citing diabetes and dermatology clinics that had been taken out of hospitals and placed in the community, but added these had been few and far between.

According to latest figures, less than half of GP practices had reported new services had been developed in the last year.

The report pointed out this had been poor return for the £100m GPs had got for signing up the scheme, which was supported by more than 90% of doctors.

Support

The authors blamed the poor relationship between GPs and the government as well as a lack of support doctors got from NHS managers and the Department of Health.

They said many doctors lacked the time and skills to make the most of the potential offered by the policy.

King's Fund chief executive Niall Dickson said: "The government is right to keep faith with practice based commissioning.

"But it must be prepared to set a clear direction, define the roles of both primary care trusts and practices, and ensure GPs have access to the support they need to make it work.

"Now is the time for a fundamental reassessment of the policy."

The British Medical Association said practice-based commissioning had so far been a "wasted opportunity".

It blamed "woefully inadequate management support" from primary care trusts for leaving GPs feeling disengaged and lacking influence.

Richard Vautrey, deputy chairman of the BMA's GPs committee, said: "GPs do need more support, but we definitely want to make this work."

Discharge letters

Dr Michael Dixon, chairman of the NHS Alliance, which represents NHS primary care, said commissioners were often starved of key information on which to base decisions.

He said the system could be significantly improving by compelling hospitals to include relevant financial information in discharge letters to GPs.

Dr Dixon said: "The King's Fund is right to say that urgent action is necessary to overhaul practice based commissioning.

"But that action need not be complex or costly. The simple solution we have proposed would transform commissioning by putting the power where it should lie - with the commissioners instead of, as at present, with the acute sector."

A spokeswoman for the Department of Health added: "We are fully committed to making practice based commissioning a success.

"We have already identified areas where it can be strengthened and we will publish a vision shortly."