EXCLUSIVE Service delivery chief says provider changes should not be included in October plans

Published: 01/09/2005, Volume II5, No. 5971 Page 5

The government has warned strategic health authorities to stop 'rushing headlong' into a redesign of primary care trust provision as part of their reconfiguration submissions.

A strongly worded letter was sent to SHA chief executives by Department of Health delivery unit director John Bacon on Friday.

In it, he instructs SHAs not to include plans to transfer PCTrun services to alternative providers in reconfiguration plans due to be submitted to the DoH by 15 October.

Mr Bacon also warns against imposing a 'one size fits all' approach to realigning PCT boundaries with local authorities.

The letter, seen by HSJ, follows vigorous lobbying from senior health service managers and membership organisations, including the NHS Alliance and the NHS Confederation.

The lobbying was a response to NHS chief executive Sir Nigel Crisp's document Commissioning a Patient-led NHS, published at the end of July.

Concerns were focused on the rush by some SHAs to find alternative providers for PCT-run services in advance of consultation on the healthcare outside hospitals white paper due at the turn of the year.

There were also worries about the insistence of some SHAs on oneto-one coterminosity with local authority social services boundaries, regardless of existing partnerships.

NHS Alliance chair Dr Michael Dixon wrote to NHS chief executive Sir Nigel Crisp last week to warn that 'misinterpretation' of the DoH guidance meant 'rushed and crude decisions' were being taken that could 'damage patient care'.

The alliance letter says that 'at least' one SHA - Birmingham and the Black Country - was insisting that PCTs complete proposals for 'the transfer of services to alternative providers' to the SHA by September, ahead of the DoH's 15 October deadline.

However, this was categorically denied by Birmingham and Black Country, Shropshire and Staffordshire and West Midlands South SHAs chief executive David Nicholson (see story, page 6).

In his letter to SHA chief executives, Mr Bacon states: 'It is unhelpful for SHAs to be rushing headlong into the design of new delivery units.' He adds that the letter is intended to 'give greater clarity' on what the DoH expects from SHA submissions on the future configuration of their PCTs by the 15 October deadline.

The submissions and subsequent consultation should focus on 'proposals and rationale for restructuring SHAs and PCTs in terms of building the PCT commissioning functions and supporting practice-based commissioning, ' he explains.

'We would not expect firm proposals on the provision functions in October, nor would we expect the consultation to cover provision, ' he writes, adding that a 'different form of consultation would be required for changes in service provision'.

Mr Bacon says the letter was sent after it became clear that 'the issue of PCT service provision has generated considerable feedback' and stresses that it 'is very important to separate the proper considerations of organisational commissioning from decisions about the provider functions'.

'In Commissioning a Patient-led NHS we have been clear that changes to PCT service provision do not need to be complete until December 2008, and PCTs will want to wait for the white paper before forming a firm view on how services should be provided, ' he writes.

He adds that SHAs must work between now and the 15 October deadline to 'engage fully with the local NHS' to ensure that 'people understand the need to rapidly enhance the commissioning function to balance the ongoing development of the provider side'.

West Yorkshire SHA chief executive Mike Farrar and DoH director of access Margaret Edwards are understood to be leading work on examining future provision, and looking at which 'essential' services might be protected in the new market.

One SHA chief executive, who did not want to be named, told HSJ that the letter 'quite reasonably reminds SHAs that the issue of PCT provision should be approached at a more leisurely pace'.