WHAT IS PRACTICE BASED COMMISSIONING PBC Dept of Health definition:

"PBC is about engaging practices and other primary care professionals in the commissioning of services. Through PBC, front line clinicians are being provided with the resources and support to become more involved in commissioning decisions.

Practice based commissioning will lead to high quality services for patients in local and convenient settings. GPs, nurses and other primary care professionals are in the prime position to translate patient needs into redesigned services that best deliver what local people want."

In practice this means that GP´s and other health providers will be given a commissioning budget which they have the responsibility for using to provide service. They will be required to identify patients needs, design effective and appropriate health service responses to these needs and allocate resources against competing service priorities ( UNISON Factsheet Dec 05).

The aim is to a have a more flexible budget that can respond to local needs and thereby start to address health inequalities. This also means that local voluntary and community groups who have specialist knowledge and expertise could be best placed to be commissioned to deliver certain services in their local area and to their particular community on behalf of the local health service provider.

The commissioning process is in two stages:

• `transformational` –where patients needs are assessed, a strategic plan is agreed to meet these needs, priorities are identifies and the services required are agreed. All of this should be done in consultation with the GP´s Liaison group and patients.
• `transactional` – where once the target services have been approved by the PCT, a tendering process or contract is given to an appropriate provider, contracts are agreed and the activity and spend is monitored. All services delivered must meet equality and quality standards.

For example a local GP identifies that many of their patients from a particular community have high smoking rates and that as a result much of their time is spent on this. They commission a local group who has strong links with that community to work with a smoking cessation health trainer to outreach into the local community and raise awareness about the health consequences of smoking and get people signed up to workshops on smoking cessation, with peer support to stop smoking.

WCEN have been commissioned by the PCT as part of ´Race for Health´ to ensure that PBC is ´equality proof´ and that the local underrepresented communities in particular BME and RAS communities are aware of this process and that GP´s are able to engage with more marginalised communities to ensure that when they prioritise services to be commissioned and when they contract services they engage with these under-represented communities.

Effective community engagement as recommended in the ´Race for Health´ Guide to policy and good practice includes the following points:

• Audit Commission research shows that the principles of effective community engagement include: commitment, support, structure, representation, willingness to hand over control, ability to learn from experience, focus on real results
• he need to involve patients and the public in all aspects of service design and delivery are enshrined in law
• Public and patient involvement should occur right at the start of service planning, development and operation
• Local community and voluntary groups are often best placed to understand and reflect the needs of particular target or geographical communities
• IT may be hard to reach a representative cross section of BME community groups. More innovative approaches, which go beyond surveys and questionnaires will be needed.
• Consultation alone is not enough.

To find out more about our work visit our website and dedicated web page: WWW.WCEN.org.uk.