Clearly Practice Based Commissioning starts with Department of Health Guidance and that can be found at ... http://www.dh.gov.uk/assetRoot/04/09/03/59/04090359.pdf

This guidance is unlike previous departmental guidance in that it espouses the principles of:

1. The rights of front line clinicians to manage a budget.
2. The expectation that this will lead to increased financial efficiencies by reducing expenditure that has little value.
3. The value of reinvesting these resources into care that the Primary Health Care Team feel is of most value.

But does not describe how it should be done. For some managers who have flourished in a directional environment over the past 8 years this is a massive shock. Our assessment on this paper can be found in our document titled “The implications of Practice Based Commissioning”.

This guidance precipitated significant debate and resulted in the publishing of technical guidance which can be found here

We have read and analysed this paper, for Xytal comments on the technical guidance: Download here

Practice Based Commissioning - Comments on the guidance.

Published by The NHS Confederation. Download here

This paper makes some good points, particularly comparing the department of health’s aspirations concerning practice based commissioning, and those claims made at the creation of primary care trusts. However it goes to a level of detail, producing a list of problems. This list is cited as a reason to doubt the initiative, whereas the departmental paper implies that these are challenges to which the answers depend on local circumstances. The financial management challenges are more taughtly cited by the chartered institute of management accountants in their document; http://www.cimaglobal.com/downloads/281004_pbc_response.pdf

This is all about policy, but what about the expected benefits? A comprehensive review of the evidence behind commissioning can be found at:
http://www.health.org.uk/uploadedfiles/document/2_82_FINAL%20REPORT%20FOR%20DISTRIBUTION.pdf

A summary at http://www.health.org.uk/uploadedfiles/document/2_82_Executive%20summary%20final.pdf This is a detailed and comprehensive paper, but strongly recommended for those practitioners who wish to achieve real benefits.
Many clinicians have understood the potential for this policy to increase the strength of decisions on care that they make with their patients. However what if none of the local choices provide the solutions that their patients seek? Then is the time to create new option.

The joint paper from the NHS Alliance, The Royal College of General Practitioners and the Royal College of Physicians on chronic disease management outlines the potential of improved systems. http://www.rcgp.org.uk/corporate/position/chronic_disease_nhs.pdf

Advanced commissioning teams will want to use the potential of Specialist Provider Medical Services and Alternative Provider Medical Services . These allow the creation of custom built community based clinical teams focussed on providing a limited range of care services.

A good overviews on APMS is provided by NAPC:http://www.primarycare.co.uk/news_pdfs/What%20is%20APMSDecember04Confed.doc
and on SPMS: http://www.primarycare.co.uk/news_pdfs/SPMS%20final%20report1.doc

NAPC, NPDT, DH, and the NHS Alliance are frequently issuing updates, advice and instructions. Xytal continuously search out, assess and analyse the implications of all new information. Register here to receive our updates on all new literature and its implications, as and when they are published.