Practice-based commissioning

Please note a new narrative on Practice-based commissioning has been published by the World Class Commissioning team on the DH website. The following needs to be read in conjunction with that script.

Practice-based commissioning (PBC) aims to increase primary care involvement in managing local budgets. PBC is intended as a mechanism through which GPs are encouraged to redesign care pathways to achieve better outcomes for local people at a lower cost.

Providing support for PBC is part of the world class commissioning competency to collaborate with clinicians and use their skills to inform commissioning intentions.

This section includes resources to support local implementation of PBC as well as reports on the overall approach.

Practice-based commissioning development framework (Department of Health 2008)
This framework enables SHAs, PCTs and practice-based commissioners to easily procure support to boost their PBC capability and skills, including clinician engagement, organisational development and leadership. The Introduction and Specification documents set out the underpinning elements of the framework.How to 'call off' services is a guide to developing individual contracts.

Practice-based commissioning podcast (CSIP)
This 2007 podcast looks at how PBC can drive up care quality, invest in less traditional services and use specialists more widely. It should be broader than primary care or general practice, says the panel, and take account of public expectations.

Practice-based commissioning: Budget setting refinements and clarification of health funding flexibilities, incentive schemes and governance (Department of Health 2007)
This offers clarification on the flexible use of NHS funds, governance arrangements and incentive schemes to support PBC, suggests local flexibilities PCTs could agree with practice-based commissioners, and outlines potential conflicts of interest.

Putting commissioning into practice: Implementing practice based commissioning through good financial management (Audit Commission 2007)
This report explores PBC from a financial management perspective. It recommends more consistent provision and assessment of business cases to ensure best use of available funds, and looks at issues of ownership, risk management and governance.

Early lessons in implementing practice-based commissioning: Key areas to focus on for success and key questions for primary care trusts' boards to consider Audit Commission (2006)
This report explores key areas to focus on in PBC implementation, challenges in engaging practices, establishing the necessary infrastructure and redesigning services, and risks associated with the move to PBC if it is not managed well.

Practice based commissioning early wins and top tips (Department of Health 2006)
This guide offers tips to support PBC within and between primary care providers, such as protocols, audit mechanisms, feedback and activity data. It uses case studies to illustrate ideas for pathway redesign in areas including long-term conditions.

Briefing: Practice-based commissioning (King's Fund 2007)
This briefing explains how PBC is intended to work, the way budgets are set and the incentives available and identifies key objectives such as delivering better preventive care and policy issues that will impact on the future of PBC.

Practice-based commissioning: From good idea to effective practice (King's Fund 2007)
This paper explores possible reasons for slow take-up of PBC, including lack of information, financial constraints and PCT reorganisation, and makes suggestions for better two-way communication and involving practices in strategic commissioning.

Practice-based commissioning (Commissioning eBook 2006)
This paper looks at where PBC fits within the context of NHS reform, and identifies the elements required for it to be effective, such as the importance of good information and financial management.

Skills for practice-based commissioning (Commissioning eBook 2006)
This paper outlines the tasks and processes required for effective practice-based commissioning. It looks at what practices and PCTs need in terms of resources and skills to develop PBC, and explores whether these are already available.

The use of simulation events in developing practice-based commissioning (Commissioning eBook 2008)
This paper explores outcomes from simulation events, which highlight the need for clear rules on engagement, incentives and risk management. Different scenarios expose ethical and practical dilemmas generated by practice-based commissioning.

Practice-based commissioning: An introduction for a local authority audience (Department of Health 2006)
This guide outlines what PBC means for social care. It offers examples of early PBC implementation, involving pooled budgets, joint managers, multi-disciplinary health and social care teams and integrated functions.