PCT mergers won’t solve financial problems, warns report
pharmafile | April 19, 2005 | News story | |
PCT mergers are unlikely to relieve the burden of financial pressures, according to a major report by the NHS Alliance.
The report argues that merging of PCT boards, management teams, or PCTs themselves, will generate only "moderate economic benefits" which are outweighed by unanticipated costs and upheaval of organisational change.
The report's findings follow mounting speculation that the number of England's PCTs will be dramatically reduced.
Financial pressures and limited management capacity has already seen up to 20% of the 303 PCTs sharing management teams, while others are making savings by sharing back office functions.
But the report argues these structural changes, which in many cases have been pushed through by Strategic Health Authorities (SHAs) who performance manage the trusts, may lead to a disgruntled workforce and a drop in productivity.
"Sound relationships," the report says, "are an essential prelude to progress."
The report says that mergers will only be successful if they have support from employees, and the involvement of frontline clinicians and local communities.
Robert Sloane, the NHS Alliance facilitator for leadership development network, commenting on the report, said: "What we have seen with mergers instigated by SHAs is they are done without forging natural alliances, like the inclusion of social services and frontline clinicians. This has not led to improvements."
While accepting that further reconfiguration of PCTs is inevitable the alliance believes there is no single blueprint for change.
The report recommends instead that major gains can be achieved through PCT associations, which allow clusters of PCTs to play a more significant role in the shaping of healthcare policy.
Sloane cites the example of Greater Manchester, where PCTs have been working collectively on a number of issues, like the possibility of sub-contracting out commissioning work.
Sloane said these PCTs have done "much good work together", stressing that the association was instigated by PCTs themselves with the involvement of the local community.
"PCTs need to be smarter about what can and cannot be done locally. This is what Manchester has been able to achieve."
Sloane said the report, conducted in conjunction with Birmingham Health Services Management Centre, was published now because a lot of PCTs were looking to initiate changes.
NHS Alliance chair Dr Michael Dixon said: "This report illustrates the cultural, relationship and environmental differences that will influence the way PCTs shape their future organisations."
Dr Dixon said the most effective organisational design in primary care will be led by PCTs answerable to local people and frontline clinicians.
