All change

The GP contract, Patient Choice, public-private partnerships. A raft of initiatives are impacting on primary care.But can PCTs deliver change alone? Graham Clews reports on an east London initiative

Now that primary care trusts have been handed the bulk of NHS funding, much of the focus has been on effective commissioning of care.

But PCTs still have a role in service provision, and as the impact of the Patient Choice initiative increases, more and more services are likely to be provided at primary care level.

The primary care facilities in many inner city areas leave much to be desired.

The opportunity to change is there but new and innovative thinking is needed. PCTs in east London have admitted that perhaps their organisations are not large enough to carry out this work as effectively as they might.

PCTs in areas including Trafford, Peterborough and Cumbria have begun to share management functions to reduce costs. NHS chief executive Sir Nigel Crisp told last month's NHS Confederation that PCTs must look towards sharing services to reduce overheads.

Now the east London PCTs have taken joint working a step further by establishing a primary care transformation unit with the help of North East London strategic health authority.

Its aim is to support new general practice developments across the area and use them as catalysts to provide new models of primary care delivery and improve local capacity.

North East London SHA director of service transformation Stephen Langford says the current quality of primary care provision in his area varies hugely.

'We have some cracking primary care and GPs, but we recognise there is a long way to go in some areas.'He says the implementation of the new general medical services GP contract will offer both GPs and PCTs extra freedoms that will allow primary care to undergo a revolution.

Increasing use of personal medical services contracts for GPs, the public-private local improvement finance trust initiative to improve GP premises and new recruitment and retention programmes all mean the time is right to overhaul primary care in east London.

But such a maze of developments means many PCTs find themselves struggling to cope with step change.Mr Langford accepts that the primary care elements of some PCTs in his patch are very small, limiting their ability to change.

Dr Bhupinder Kohli, who was professional executive committee chair of Newham PCT until March, says many PCTs have the vision, but a combination of a lack of management time, expertise and experience means it is difficult to realise. 'Now things will happen that otherwise might not. People working in PCTs are so busy that they cannot even cross the road.'

The unit, which was launched last week, will assess primary care development needs across the SHA, identify models of development, provide expertise and source experts from among PCTs, as well ensuring such knowledge is transferred through a learning network.

Research carried out by the SHA has revealed that managers want support in developing services based on local need, planning and design support, help with accountability and clinical governance, and new ideas in changing skill-mix.

Though the SHA has coordinated the development of the unit, it does not want to be seen as heavy-handed, 'instructing' PCTs on how to provide services.

The unit will be accountable to a steering group comprised of members from PCTs, the SHA and North East London workforce development confederation.Mr Langford says:

'We are not trying to supercede PCTs but to bring them together.

This is not about us telling the PCTs what to do.

SHA assistant director for primary care Rigo Pizarro says it will operate as a cross between a support group and a management consultancy. And so far, the PCTs involved have been delighted with what they have heard.He says: 'One PCT said, fithank God we have somewhere to go and someone to talk tofl.' l