Questions remain on how the new PCTs will work in practice

Published: 04/04/2002, Volume II2, No. 5799 Page 19

Welcome to the new NHS - latest version. It has now become a firmly established tradition that the beginning of April arrives accompanied by a health service reorganisation. This week sees the debut of more potent primary care trusts and 30 strategic health authorities. It marks the long-awaited achievement of that concept which first surfaced in the mid-1990s under a Conservative government: the primary care-led NHS.

Policy-makers especially reached easily and often for this phrase, though any exact definition remained elusive. Perhaps it still does. Many unanswered questions remain about how the new PCTs will work in practice, though as of this week they control three-quarters of the NHS budget for England, while both commissioning and managing services.

With the best will in the world, it is hard to deny that PCTs have had an inauspicious start. They are for the most part - and would themselves be the first to admit - immature organisations which have been hothoused to reach this stage in their development. Some are saddled with debt and a lot of other undesirable baggage inherited from their predecessor bodies. In the vivid words of one PCT chair, they are 'a jigsaw made up of bits of other jigsaws'. Many are struggling to recruit staff, even chief executives in a few cases. The PCT finance function remains so woefully underdeveloped that contemplating the vast sums for which they have just become responsible would make any experienced NHS finance director feel distinctly queasy.

Unsurprisingly, whole tranches of health professionals remain sceptical that PCTs stand a fighting chance of fulfilling the high hopes invested in them.

Despite all this, we wish the new kids on the block every success. Clearly they will need it. It has been a high-risk strategy to reorganise the service yet again at this point in the NHS plan's implementation. It has dismayed most staff, not simply those it has displaced, by forcing so many to focus internally at the very moment when they should have been focusing externally as never before to convince the public the NHS is changing for real.

Ministers remain adamant this reorganisation will benefit the service and speed up reform. Let us hope for the sake of the NHS and its patients that they are right.