Chris Lancelot on ... Practice-Based Commissioning

How is practice-based commissioning (PBC) doing in your area?

Are you ahead of the game? Our group has met frequently, taking up many hours of medical time. Consequently it has paid large amounts in expenses to doctors and practice managers.

And of course we've got a lot of statistics - in fact, we're drowning in them. During most weeks I receive two or three emails from our PBC manager, each with multiple attachments of densely typed spreadsheets and pretty coloured graphs. My practice manager is drowning in paperwork and statistics (all of which need intensive checking) and is quietly losing the will to live.

But doesn't it look impressive? Don't you get the feeling that we are running the health service - in charge at last, doing the right thing? Actually, no. NHS data are simply not dependable. Although the NHS collects vast amounts of detailed information it has ignored the first rule of statistics, which is that data have to be consistently accurate before any conclusions can be drawn from them.

And the data are anything but acceptable. Our practice's listed hospital activity includes large numbers of patients who aren't ours. Other patients have been double-counted; or incorrectly logged as having undergone procedures which were never performed; or recorded as being admitted for far longer than they actually were in hospital. This immediately begs the question: even if we do manage to reduce our referrals under PBC, how are we going to prove it if the statistics are so unreliable?

I doubt whether our PBC group will actually achieve any savings: so far all we seem to do is endlessly discuss protocols without getting anything practical done. In all the time we have spent working on PBC hardly anything has been put in place that improves patient care or delivers it more economically. All we get are increasingly strident calls to refer less, as each day we go a little bit more into the red.

PBC is delivering everything I predicted and nothing that the politicians desired. It is a waste of time, money and effort: it introduces yet another layer of officialdom; but worst of all, the huge amount of time it absorbs takes highly qualified GPs away from their real job of patient care.

However, it does produce some nice graphs: and all in bright colours, too.

Dr Lancelot is a GP from Lancashire. Email him at .

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