1. The great majority of English people do not know
what commissioning is or what a Primary Care Trust (PCT) is. Yet
commissioning is a key function of the NHS and PCTs are important
institutions which spend about 80% of the NHS's annual budget
of £100 billion. In part because of the central role PCTs
play in the NHS, they are constantly subject to criticism. Scarcely
a week passes without the revelation of new failings. The week
before this report was agreed PCTs were criticised for not spending
Government allocations earmarked for carers.
We held an evidence session on the use of EEA doctors in out-of-hours
services, which presented us with an appalling catalogue of the
negligent behaviour of some PCTs.
2. Many of our reports have been critical of PCTs.
On dentistry, we found that many PCTs had failed adequately to
assess the needs of their population or commission services.
On patient safety, we concluded that PCTs had not paid attention
to the quality of services hospitals were providing.
None of the examples of appalling care provided by hospitals in
recent years had been detected by the local PCT. In our report
on Lord Darzi's Next Stage Review we doubted whether PCTs
had the ability to implement the reforms he advocated.
Given our repeated expressions of concern about PCTs, we decided
to undertake a more thorough study of commissioning with the following
terms of reference:
- "World-Class Commissioning":
what does this initiative tell us about how effective commissioning
by PCTs is?;
- The rationale behind commissioning: has the purchaser
/ provider split been a success and is it needed?;
- Commissioning and "system reform":
how does commissioning fit with Practice-based Commissioning,
"contestability" and the quasi-market, and Payment by
- Specialist commissioning;
- Commissioning for the quality and safety of services.
3. We received 121 memoranda and held 4 oral evidence
sessions. We would like to thank all those who gave evidence and
our advisers, Dr Daphne Austin and Professor Alan Maynard who
provided us with expert guidance about this complex subject.
1 "Millions of pounds promised for carers has
been diverted to plug NHS debts", Daily Telegraph, 6 March
Oral evidence taken before the Health Committee on 11 March 2010,
HC 441 Back
Health Committee Fifth Report of Session 2007-08, Dental Services,
HC 289-I Back
Health Committee, Sixth Report of Session 2008-09, Patient Safety,
HC 151-I Back
Health Committee First Report of Session 2008-09, NHS Next Stage
Review, HC 53-I Back
They declared the following interests: Dr Daphne Austin declared
her interest as Chair of the UK Commissioning Public Health Network,
and Consultant in Public Health, West Midlands Specialised Commissioning
Team, and Professor Alan Maynard declared his interest as Chair
of the York Hospitals NHS Foundation Trust, Professor of Health
Economics, Department of Health Sciences, and Hull-York Medical
School, University of York Back