Comment: PCTs need certainty of consultations to innovate

The Appeal Court's decision to send North Eastern Derbyshire primary care trust's contract with UnitedHealth Europe back to the drawing board is anything but a victory for patients, despite what campaigners claim.

UnitedHealth was chosen from a shortlist of six and there is nothing in the court ruling that suggests the actual choice was wrong. The PCT's belief remains that the company is the best-placed organisation to improve services the two practices provide to local people. What will, for the time being, prevent that happening is the ruling that the PCT did not consult properly with the community about what judges say amounted to a significant change in services.

Where does that leave PCTs considering similar moves? On one hand they could take heart that Derbyshire's other soon-to-be-merged PCTs have just signed a joint alternative provider medical services deal with UnitedHealth to run practices in the Normanton area, with no apparent problem. On the other, they will fear that the need to do detailed consultation every time there is a proposed change in services will be both prohibitively expensive and time consuming.

You cannot be certain of a consultation's outcome, however important to you, but that makes it all the more vital you are certain of the process. North Eastern Derbyshire originally believed it was acting on the advice of the SHA and DoH - now it believes the ruling provides clarity.

But PCTs need to know from the Department of Health exactly what is legally appropriate in terms of consultation - that would ensure that this case was a useful precedent. Instead the DoH claims it has 'no wider implications'. That may be true in the sense that the broad direction of travel towards a mixed NHS economy will continue.

But without addressing the issue of what constitutes proper section 11 consultation, the deadening effect on PCT innovation may in practice be huge.