National evaluation of general practitioner commissioning pilots: lessons for primary care groups

Background. The national evaluation of general practitioner (GP) commission ing pilots was commissioned by the Department of Health in 1997 as part of its Policy Research Programme. It was conducted by the Health Services Mana gement Centre at the University of Birmingham. Aim. To monitor the development of the 40 national pilot sites, identify th e factors that inhibited or facilitated progress, and consider the implicat ions for the implementation and development of primary care groups (PCGs). Method Semi-structured face-to-face interviews with GPs, health authority ( HA) managers, and pilot managers from each of the 40 pilot sites (141 inter views in total) and focus group discussions with nurses, social services of ficers, and community health council officers in the 40 sites. Results Stakeholders reported the key achievements of the pilots during the ir first six months as being improved collaboration between GPs, the establ ishment of organisation al arrangements, and work towards managing the grou p prescribing budget. Obstacles for the groups included changes to governme nt policy regarding primary care, the workload involved for clinical staff, the pilots' relationship with the local HA, and problems with information management and technology (IM&T). A more detailed analysis of the pilots' m anagement arrangements, prescribing work, IM&T support, and stakeholder inv olvement points to a set of lessons for emerging PCGs. Conclusions. In their early stages of development, PCGs are likely to focus on issues of structure and process. Prescribing will be an area receiving particular attention, prefiguring some of the challenges of clinical govern ance in primary care. IM&T will prove to be more problematic than first ass umed. The involvement of a wider range of stakeholders will be addressed by primary care groups, particularly in relation to GPs and nurses.