Support for practice-based commissioning (PBC) is crashing again, despite the DoH's attempt to revive the policy last month, a GP poll reveals.

Experts say an impending change of government and the credit crunch could be causing its continued stagnation.

The survey of 380 GPs reveals just 16 per cent feel positive about the future of PBC. Many more - 39 per cent - feel negative about it, while 45 per cent are nonplussed, feeling neither positive nor negative.

But tellingly, more than 40 per cent feel less positive about PBC than this time last year.

The DoH's own survey reports a brighter picture, with two-thirds of GPs backing PBC. But figures from March show the number of practices that had received their own budget dropped since the previous survey in December 2008.

DoH director of primary care Dr David Colin-Thome has said a third of GPs need to back PBC for it to take off and that this has been achieved, but GP's figures cast doubt on this.

GPC member Dr Kailash Chand describes the DoH's quarterly PBC surveys as 'spin'.

'The truth is that the majority of practices do not have indicative budgets,' he says. 'GP's poll is more realistic than the DoH's.'

NHS Alliance PBC lead Dr David Jenner agrees the GP poll is an accurate reflection of grass roots opinion. 'It's interesting how different it is to the DoH survey. GPs agree with the principle, but not with how it's being done,' he says.

Dr Chand says GPs sensing a change of government are unlikely to be responsive to struggling policies like PBC.

The Conservatives recently outlined plans to make GPs manage commissioning and rationing decisions, potentially leaving PBC obsolete, and have led the polls for 18 months.

'Grass roots GPs may think the days of this government are numbered, and ask "why should I get involved?"' Dr Chand says.

Respondents to the GP survey seem to agree. 'PBC is moribund - I'm just waiting for the next election so that it can be quietly buried,' one writes.

Commissioning would be 'radically changed,' under the Conservatives, says Dr Chand. 'GPs can sense that,' he adds.

Dr Jenner disagrees. 'We will not have to start again. But it has passed the point already where GPs start to lose interest.'

The credit crunch has also hit interest in PBC, he adds, leading PCTs to ignore DoH policy and focus on financial balance.

Last month's PBC vision document from the DoH 'sank without a trace', and the idea that potential savings are an incentive for GPs is 'dead in the water', Dr Jenner says.

Responses to the GP survey echo this. 'How can you get enthusiastic about PBC when your PCT takes all your savings because it is in the red?' one GP writes.

Dr Chand urges GPs who have made progress not to give up on PBC. 'Let's accept it's here to stay, and see what it can achieve before it becomes compulsory.'

At least one survey respondent is prepared to carry the flag. 'PBC is the country's best hope for evidence-based cost-effective quality medicine,' he writes.

tom.ireland@haymarket.com

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