Another reshuffle: PCTs under growing pressure to merge
pharmafile | March 15, 2005 | News story | |Â Â Â
England's primary care trusts are under growing pressure to merge, and their numbers could be reduced by a third within just a few years, according to NHS observers.
It is just two years since 303 PCTs took control of 75% of the NHS budget in England, the organisations themselves formed through the merging of the smaller, more localised Primary Care Groups.
But health service observers such as NHS Alliance chief executive Michael Sobanja, say numbers could eventually be cut to between 100 and 150 PCTs, radically reshaping the NHS' bureaucratic structure once again.
Neighbouring PCTs in Greater Manchester, Liverpool, Hampshire, and Cambridgeshire are already sharing chief executives and strategic planning, with up to 20% of PCTs nationally now understood to be sharing management teams.
The incentives for mergers are evident – PCTs can increase management capacity by sharing resources and chief executives and make savings in back office functions such as intelligence and human resources.
But the NHS Confederation and the NHS Alliance have warned against the creation of super-PCTs for their own sake, saying this would defeat the object of the bodies, which were designed to better understand and meet local need by being nearer to the primary care frontline.
The Department of Health has echoed this view in an official statement but also indicated that it would not intervene to block local decisions to merge PCTs.
Pressure on PCTs to merge comes from a number of directions, but Strategic Health Authorities, who performance manage the trusts, often provide the greatest impetus.
Speaking at a recent press conference held by Takeda to promote its new sales model, Conservative Peer Baroness Cumberledge said Hampshire Strategic Health Authority pushed three of its local PCTs into a 'forced marriage' – chief executives of the organisations having to decide in just one afternoon how they would work together.
She said the process was nevertheless amicable, but added: "That's not the way to build partnerships."
Jo Weber, policy manager at the NHS Confederation said: "Our view is that no single size of PCT fits all local requirements and so flexibility should be retained to meet local circumstances, and it is inevitable that there may be some reconfigurations and mergers of PCTs as their roles and responsibilities change."
Sally Standley is chief executive of both Cambridge City PCT and South Cambridgeshire PCT, which have been working in partnership under her stewardship since June 2004.
The merging of executive boards was backed by a local Strategic Health Authority after Cambridge City PCT chief executive joined another PCT and South Cambridgeshire PCT needed to find a new finance director.
They now share one chief executive, one management team and one administration. The two Professional Executive Committees even meet together although they retain their autonomy.
A chronic shortage of high quality managers and a need for more commissioning muscle are two further motivating factors behind the trend.
"The idea was to increase management capacity and not to reduce costs or the number of managers. With all the new things PCTs need to do, like implementing NICE guidance and the introduction of Payment by Results, we needed to increase our capacity but not increase cost," Standley added.
She said the money saved will be reinvested in areas where more capacity is needed.
Most importantly, a strengthened finance and performance function will help the PCTs achieve financial recovery.
Asked about the direct significance for pharma companies, Standley said: "Our PCTs still have two pharma advisers and two prescribing sub-committees, but it is not necessary to have two prescribing advisers attending every PCT meeting. It is about making sure we identify the issues and having connectivity whether it is pharmaceuticals or administration."
As statutory bodies, the official merging of two PCTs would require extensive public consultation and legal wrangling, something which trusts and SHAs are keen to avoid, for the meantime, at least.
Hampshire and Isle of Wight Strategic Health Authority chief executive Gareth Cruddace made it clear that complete mergers are not envisaged, citing "risk of disruption; staff distraction; loss of engagement among healthcare professionals and weakened local focus", but others predict pressures could eventually see mergers formalised.
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