Family Practice Vol. 19, No. 5, 570-571
© Oxford University Press 2002
Book review |
The purchasing of health care by primary care organizations; and evaluation and guide to future policies.
Nicholas Mays, Sally Wyke, Gill Malbon, Nick Goodwin (eds). (341 pages, £25.) Open University Press, 2001. ISBN 0-335-20900-9.
Associate Dean in Postgraduate General Practice, London
This book has two objectives. The first is to review the potential for effective purchasing of health care in the UK by primary care organizations. The second is to compile and review the research information about Total Purchasing Pilots (TPPs).
In this book can be found a clear account of the development through the various stages from the inception of fundholding in 1991 through TPPs (1995–1998) to Primary Care Groups (1998–2002). It brings together the evidence for what has been successful and what has not been successful, and uses this to project forward for Primary Care Trusts the possibilities and potential pitfalls.
TPPs were proposed in 1994 as pilot projects to extend the range of services which fundholding general practices could purchase. They could negotiate a budget with their Health Authorities to cover the commissioning of Maternity Services, Mental Health Services and Emergency Care. Fifty-three TPPs were established in 1995, and 35 more in 1996. Their effectiveness was curtailed with the advent of the Labour Government in 1997 and they were abolished in April 1998. There was therefore little time for TPPs to establish their organizations and to achieve their aims of improving ser-vices by moving resources from secondary to primary care. This was compounded by poor activity data and the costing being at marginal rather than average cost. In addition, some Health Authorities were unsupportive.
Considering these limitations, it is not surprising that the achievements were modest and patchy. The TPPs were run as pilots, and arrangements were made to collect information about how well they achieved their stated aims. It looked temporarily as if the government might, in future, look for evidence before setting up a nationwide scheme.
Unfortunately, before TPPs could get established, the new Labour Government announced changes which would eliminate TPPs along with fundholding and the large research programme which had involved up to 30 researchers, and 4 years work ended up with modest findings which this book details.
However, from their findings, the authors do come up with recommendations which should be important for Primary Care Trusts. These include:
- Effective commissioning depends upon good relationships with providers, good activity and cost data, and agreement about ‘average’ costs.
- Innovation from the ‘grass roots’ can lead to valuable changes.
- Effective ways need to be found to move resources from secondary to primary care.
- NHS organizations need time to become established and effective.
This work has been a brave attempt to evaluate a pilot scheme in order to base innovations on evidence rather than leave the NHS to be driven by the latest political dogma. This should (but probably won’t) be a warning to government to stop being meddlesome.
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