Commissioning - Health Committee Contents


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.[1] 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]

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.[3] On patient safety, we concluded that PCTs had not paid attention to the quality of services hospitals were providing.[4] 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.[5] 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 Results?;
  • 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.[6]

1   "Millions of pounds promised for carers has been diverted to plug NHS debts", Daily Telegraph, 6 March 2010 Back

2   Oral evidence taken before the Health Committee on 11 March 2010, HC 441 Back

3   Health Committee Fifth Report of Session 2007-08, Dental Services, HC 289-I Back

4   Health Committee, Sixth Report of Session 2008-09, Patient Safety, HC 151-I Back

5   Health Committee First Report of Session 2008-09, NHS Next Stage Review, HC 53-I Back

6   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

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Prepared 30 March 2010