Mergers will create gulf between GPs and PCTs
pharmafile | January 20, 2006 | News story | |Â Â Â
Health service leaders have warned that planned mergers of Primary Care Trusts in England will create larger bodies more remote from the primary care staff charged with leading NHS reform of services.
The number of PCTs in England is set to be halved to around 150 as early as October this year in order to strengthen their financial and commissioning power -but the NHS Alliance has warned that this could create a gulf between managers and frontline clinicians.
The Alliance said the changes could worsen the problem of primary care professionals being disengaged from the drive to improve services, and said a new two-tier model of clinical leadership is needed.
Currently, each PCT has a group of frontline clinicians, called the Professional Executive Committee (PEC) who are charged with bringing about patient-based reform to services. The NHS Alliance said a new second tier of more local groups is needed to champion reform. It calls for:
- A redefined, smaller and more focused PEC at the PCT level – called the Clinical Executive – to emphasise its equivalence to management; and
- Area Commissioning Forums at local community level that would provide clinical leadership and management support to practice based commissioners in their areas.
- Integrated clinical leadership throughout the NHS, from primary care to the upper reaches of the Department of Health, rather than its present status as a discretionary add-on.
The paper's author, Dr Peter Reader, said: "One effect of reducing the numbers of primary care trusts will be the loss of local clinical leaders – perhaps as many as 2,000. Yet we need more clinical leadership not less. Without local leaders, the NHS cannot expect to build the trust they need to develop practice based commissioning, redesign services and see the effective management of payment by results and initiatives like patient choice."
NHS Alliance chairman Dr Michael Dixon said: "The NHS needs a revolution if it is to get away from the traditional and out-dated tribalism between clinicians and managers. It is only by working together in equal partnership that the health service can move forward. Dr Peter Reader's brilliant paper demonstrates how that can be achieved."
Practice-based commissioning (PBC), where GPs and their staff control budgets and lead reform has been introduced to accelerate change, and came about in part because of the lack of impact made by many PCT PECs.
But recent indications from GPs show many are shunning the chance to take on the budgets, despite a government drive to have a 100% uptake of PBC by the end of 2006.
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