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HSJ webcast - white paper major challenge for PCT management

Senior managers at primary care trusts are facing the tough challenge of managing major change while dealing with staff who have been publicly criticised, Ealing PCT chief executive Robert Creighton said on HSJ’s webcast on the government’s white paper.

Mr Creighton said: “Staff have been told quite publicly that the job they have done is inadequate, inappropriate, sometimes very poor, and [PCTs are] going to have to be replaced.

“Their jobs are at risk and it is a very, very challenging time for me, my directors, my board, the non-executives, and my GP colleagues, many of whom work very closely with us and don’t share the view that what we have done is not as good as it should be.”

Mr Creighton said the NHS could not rely on GPs’ natural incentive to provide better care for their patients when managing the new GP commissioning consortia.

“That does not get anywhere near them understanding the responsibilities of decision making, and understanding risk and all the things that I get paid for by being a responsible officer,” he said.

“It can be a scary place when you don’t know where you’ll be at the end of the year and you will be held accountable for that.

“I can’t believe there are enormous numbers of GPs who want to do that because it is the right thing to do. There need to be incentives to get GPs to come forward to take these difficult roles and no one seems to have thought these through.”

Royal College of GPs president Steve Field said in many areas GPs had been pushed out of decision making by PCTs, and he said he was confident that GPs had the skills to manage commissioning consortia with the right support.

Katherine Ward, chief executive of United Health UK, said GPs were well placed to see efficiencies at a local level, and she said private providers would be able to supply IT and data analysis support, particularly to help GPs understand the valuable data they held at a population level.

Speaking on the NHS Local website, Sue Davis, chair of Sandwell and West Birmingham Hospitals Trust, described the government’s white paper as a “risky step” which could lead to an impasse in major health service decisions.

She said the transition period represented “an enormous period of danger for health services”.

“I think there is an anxiety across the provider network, across the NHS as a whole, that this level of change, and these are very radical changes, will lead to a long period of uncertainty and a period in which no major decisions about new services are made and at a time when we all need to be focused on improving quality and driving down costs.

“I do think that that is a severe risk and one we all need to be guarding against.”

Readers' comments (7)

  • There is massive perception gap in PCTs especially their CEOs and boards. They have failed to deliver an efficient and effective commissioning service, but they think they are doing a world class job. This is contrary to the Health Select Committee (“HSC”) report which said it was ‘poor to mediocre’ at best.

    The changes in the NHS White Paper are simply the combined manifestos of the Coalition parties, which has 64% share of the electoral vote. The Libdems manifesto stated they would “scrap Strategic Health Authorities”. The Conservative party stated they would “give them [GPs] the power to hold patients budgets and commission care on their behalf”; and “remove the need for expensive layers of bureaucracy to oversee the NH S”.

    If the HSC report stated that PCTs and SHAs were doing an effective and efficient job (never mind world class job), Lansley would not have had the evidence or political backing to make these radical changes. PCTs and SHAs boards have brought this demise on themselves. They have failed their staff and patients by their poor resource allocation decisions over the past 8 years, and consequently delivering very poor value for the £110bn annual investment.

    PCT and SHA boards are still going to be paid vast salaries and huge pensions over the next 3 years. So, if PCTs and SHAs wish to salvage their reputations and show the NHS that they are as good as they say they are these boards need to collectively: 1) deliver £19bn worth of productivity savings before April 2013; 2) ensure the delivery of high quality patient care; and 3) achieve at least European levels of health outcomes. If they do this they may find that GP Consortia and the NHS Commissioning Board are simply PCTs and SHAs that have been rebranded.

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  • Robert Creighton is a hero - he is being honest and telling it how it is despite David Nicholson's coded instructions to shut up and get on with it.

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  • Ealing is one of the better run PCTs in London with a history of sound financial management. More than can be said for some of its neighbours....

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  • Anon 10:02 is maintaining the stunningly high quality of debate on this isuue in these pages.

    Makes you want to weep.

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  • The Health Select Committee report is being quoted on a selective basis to support the arguments for change. However in it's conclusion, the recommendation was to retain PCTs and give the PCTs the necessary levers to be able to deliver effective commissioning and leadership of the NHS.

    Whilst PCTs have failed to deliver what was expected of them, the problems are more systemic and not just down to bad management. The current commentary in the HSJ is excessively critical of PCTs and ignore the fact that PCTs were driven by top down demands and distractions. PCTs have been required too often to knee jerk to the latest dictat from the department. Transforming Community Services was/is a good case in point.

    SHAs and PCTs are required to make the £15 to £20 Billion savings over the next few years and it is vitally important that we as leaders in the NHS deliver today's agenda at the same time as planning the transition to a new world. Maintaining morale and motivation across the whole of the NHS family is crucial and is not helped by the continual negative comments that I have been reading over the last few weeks.

    Which part of the NHS will be the next scape goat for sytemic failure?

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  • No-one is putting their hand up to say what a brilliant policy this is. We all seem resigned to implement something that will cost money and deliver nothing, except privatisation of the NHS. The Goverment seem intent on forcing through something that is probably based on the private discussions between Andrew Lansley and his GP wife.

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  • NHS management is resilent and can accommodate any change whether they support it or not !! It is time to concentrate on implementation and influence the outcome We need to control the pace of change and ensure that the primary objective of giving greater freedom to the service locally is achieved

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