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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 May 26; 334(7603): 1079.
PMCID: PMC1877960

Trusts' lack of support threatens practice based commissioning

GPs and practice managers in England are struggling to implement practice based commissioning, a survey shows, because of problems getting support and information from their primary care trusts.

More than half of the respondents to the survey (53%) say that because of such difficulties they are failing to reap any benefits from commissioning for their patients, the very reason that the government introduced the policy in 2004.

The survey, carried out jointly by the healthcare think tank the King's Fund and the NHS Alliance, comprised an emailed questionnaire sent to 600 members of practice based commissioning and practice management networks run by the alliance. It garnered 257 responses.

The results show wide support for practice based commissioning, with 73% of respondents saying that they are firmly committed to the policy. But more than a third (39%) of respondents cited lack of support from their trust as a problem, while nearly a quarter (23%) cited financial constraints and short term thinking as barriers to implementation.

Only 3% of respondents to the survey said that their trust involved them in strategic planning to a “great extent,” and 21% said that their trust involved them to “some extent.” And 70% said they had not agreed a budget for commissioning with their trust for the last financial year (2006-7). Of those who did have a budget, 37% did not understand how it had been set.

Richard Lewis, senior fellow in health policy at the King's Fund, said, “This reform may fail if PCTs [primary care trusts] do not provide GPs and others in primary care with the right support. Above all, practice based commissioners need sound information and proper budgets if they are to be effective in their new roles.”

David Stout, director of the NHS Confederation's PCT Network, which represents primary care trusts across England, says that evidence from a survey of 31 trust leaders carried out by his organisation in April contradicts the latest findings.

He said, “A recent NHS Confederation survey of PCT chief executives found that 84% believed they are resourcing the implementation of practice based commissioning adequately. In the minority of areas where there are issues, this is largely because of the impact of restructuring and delays in filling all management posts.”

A report from the King's Fund and NHS Alliance, which includes the findings of the survey, lists a number of recommendations to ensure that practice based commissioning is implemented consistently across the NHS.

As well as agreeing budgets with practices, it stresses the need for better information about services, management support, protected time for clinicians to implement and handle commissioning, and an incentive scheme to encourage uptake. Trusts and practices should also produce an annual report in which they itemise the changes to the care they provide that are due to commissioning.


Practice-Based Commissioning: From Good Idea to Effective Practice is available at

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