PBC is alive and real budgets a ‘maybe’, says tsar

Posted on October 26, 2009. Filed under: Journals | Tags: |

Pulse | 26 October 2009

Primary care tsar, Dr David Colin-Thome has set the record straight about reports he called PBC a ‘corpse’.

He told Practical Commissioning: ‘I asked a rhetorical question – I can’t remember the exact words, but it was essentially, are we reinvigorating a corpse? I then went on to say that actually there is plenty of good practice which is hardly saying there’s a corpse. And actually all the press reported that I was saying that there’s good in parts. What I’m saying is we need to get those energetic (PBC groups) to have more influence and power and maybe (real) budgets and need to be even more ambitious about what we can do in re-shaping care.’

He added real budgets were ‘always part of our policy if people were confident enough. And that’s a local decision.’

Primary care tsar, Dr David Colin-Thome has set the record straight about reports he called PBC a ‘corpse’.
In his speech to the NHS Alliance conference this week, health minister, Mike O’Brien, said: ‘Some of you may have read David’s reported description of practice- based commissioning as being like a ‘corpse’..

Well, reports of its death have been greatly exaggerated.’

‘It is certainly true that it has not taken off everywhere, and we need to change that, but, and as indeed David Colin-Thomé actually said in his speech, where it has the results have been truly impressive.’

Click here to find out more!Primary care tsar backs PBC

Pulse | 23 October 2009

National primary care tsar Dr David Colin-Thomé has insisted that he continues to support Practice Based Commissioning – just days after describing the troubled initiative as a ‘corpse not for resuscitation’.

Speaking at the NHS Alliance conference in Manchester, Dr Colin-Thomé said: ‘Of course I don’t think the darn thing’s dead.’

His remarks at a conference in London earlier this month had been misinterpreted, he claimed but he added: ‘I’m certainly disappointed with the impact PBC is having.’

Health minister Mike O’Brien also moved to defend the under-fire initiative in his keynote address to delegates, insisting ‘reports of its death have been greatly exaggerated.’

He said: ‘It’s certainly true that it’s not taken off everywhere and we need to change that. But as David also said in his speech, where it has taken off results have been truly impressive.’

Primary care czar jokes about PBC ‘corpse’ blunder

Healthcare Republic | 22 October 2009

Primary care czar Dr David Colin-Thome has said his description of practice-based commissioning (PBC) as a ‘corpse not for resuscitation’ was misunderstood and even joked about the blunder.

Addressing the NHS Alliance annual conference in Manchester on Wednesday, Dr Colin-Thomé said: ‘Perhaps the C in (my initials) DCT should stand for corpse, not Colin.’

Dr Colin-Thomé, England’s clinical director of primary care, made the controversial comment last week and it has been the talk of the NHS Alliance conference this week.

Health minister Mike O’Brien also took advantage of his appearance at the conference to defend PBC.

Mr O’Brien maintained that Labour’s drive to improve quality could deliver enough efficiency savings to reign in NHS finances.  ‘The only way forward in these times is to continue on the reform path we are on,’ he told delegates.

Earlier, shadow health secretary Andrew Lansley set out his vision of a drastically different NHS, where GPs commission all local health services for their population, including urgent and emergency care.

Mr Lansley said patients wanted GPs to make difficult rationing decisions about the care available to them. 

‘There will always be rationing in the NHS because we have finite resources. But ask people who they trust to make these difficult judgements – it’s not the secretary of state, it’s not PCT managers. The public are looking for someone they can look to, to manage their care.’

GP commissioning shows little sign of life – David Colin-Thomé

Health Service Journal | By Steve Ford | 14 October 2009

The government’s primary care tsar has admitted that efforts to “resuscitate” the “corpse” of practice based commissioning have had little effect.

National clinical director for primary care David Colin-Thomé said last week that the Department of Health is “hard at work trying to reinvigorate” practice based commissioningbut said it “isn’t really taking off, in any systematic way”.

He told delegates at the Wellards annual conference in London that it was hard to say why this was. “But it’s certainly not seen as a major vehicle for change,” he said.

The DH published extra guidance in March intended to mark the start of a new push to get practice based commissioning “working to its full potential” – five years after the policy was first launched. 

The document, Clinical Commissioning: our vision for practice based commissioning, included various ideas intended to try to “reinvigorate” the stalled policy.

It set out entitlements that commissioners could expect, including that primary care trusts should make decisions on practice plans and business cases within a maximum of eight weeks, and that PCTs would be held to account for the quality of their support.

Dr Colin-Thomé said: “We thought we’d try and reinvigorate it, and we had all sorts of ways of doing it – entitlements and things like that.

“But I think the corpse is not for resuscitation. There doesn’t seem to be much traction,” he said.

“We’re struggling to make it systematic,” he added. “There’s a lot of support around it but it’s not really taking off out there.”

However, Dr Colin-Thomé insisted that clinicians do need to have some form of budgetary responsibility in order to “reshape how clinical care is provided and challenge inappropriate and ineffective interventions”. “Clinicians, doctors especially, we spend the money,” he said.

The apparent failure of practice based commissioning has not deterred the Conservative Party from sticking to its policy of giving GPs “real” budgets if they win the election.

Writing in HSJ earlier this month, shadow health secretaryAndrew Lansley said: “We will hand them real budgets to manage the costs of their patients’ care. They will have a direct incentive to buy the most efficient services on behalf of their patients, because they will be able to keep any savings and use them to reinvest in care.”

Speaking at the Wellards conference last week, NHS Confederation director of policy Nigel Edwards said the Conservatives were “basically betting the ranch on hard budgets for GPs as a mechanism for change”.

“I’m torn on this,” he told delegates. “There are some big questions.”

Mr Edwards said he would have no concerns about GPs he had met who already do practice based commissioning and “do this well”. But he said: “There are some really interesting questions about what to do with the people who don’t want to do it or don’t have the skills or the capacity.”

He added: “The other issue of course is that GPs are also providers. If you want to bring new providers in, which is also part of Conservative policy, then it’s quite hard to do that if the commissioner is one of your potential competitors.”

Birmingham East and North PCT chief operating officer Andrew Donald said: “I tend to agree with the principle of giving GPs hard budgets because actually they are the ones who create most of the cost. They write referrals, they write prescriptions, their patients got to A&E, their patients have emergency admissions.”

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