Practice-based commissioning is a key reform for the National Health Service. It is an important focus of the Audit Commission's local audit work and our national work on financial management in the NHS.
Drawing on evidence from those primary care trusts (PCTs) which are furthest ahead, it identifies the key areas that PCTs and practices should be focusing on in the early stages of implementation and sets the scene for a fuller national report on practice based commissioning, published in early 2007.
The key areas to focus on for success and key questions for primary care trusts' boards to consider are:
- strategy
- clinical engagement
- managing the finances
- information
- supporting practices
- governance arrangements
Possible risks associated with the move to practice-based commissioning, if not managed well include:
- exacerbating financial pressure at PCT level
- widening inequalities of provision and access between areas
- delivering poor value for money overall
Practices play a central role in overcoming these challenges and managing the risks. However, as the organisations responsible for implementation and strategic commissioning, it is PCTs, with the support of their strategic health authorities (SHAs), that need to ensure that practice based commissioning is implemented and managed effectively.