Published: 08/09/2005, Volume II5, No. 5972 Page 6
Primary care trusts' hard-won relationships with clinicians will be put in jeopardy by the restructuring of PCTs, chief executives say.
Over 80 per cent of the primary care leaders who responded to HSJ's survey of their views on the impact of the new policies for primary care - unveiled in Commissioning a Patient-Led NHS - said it would damage clinical engagement.
The document set out a timetable to restructure PCTs by October 2006, to complete roll-out of practice-based commissioning two months later and to abandon the bulk of service provision by December 2008.
Eighty-three per cent of respondents said the policies would have a negative impact on clinical engagement.
More than one chief executive told HSJ the reconfiguration was 'potentially dangerous' to the successful roll-out of practice-based commissioning.
'The success of the new arrangements will depend on how effective PbC is in tackling the deep-rooted supply-led demand issues within the NHS, ' said one. 'It would make sense to ensure that this is working and clinicians are engaged before PCT morph to cover much larger areas.' They added: 'This PbC change needs good local relationships to support practices and local clinicians taking on these changes and a strong focus.
'While some areas are well ahead with this work, most are not and it is potentially dangerous to significantly increase the number of new relationships with PbC groups a PCT needs to manage by reducing the number of PCTs before this work is further forward.' Another chief executive worried that the rapid roll-out of PbC combined with the reduction in PCT control and influence would endanger stability in the NHS. 'While we are strongly in support of PbC, the reliance on the part of the NHS over which [we have least control] to deliver change...seems extraordinarily risky, ' they told HSJ.
Meanwhile, another chief executive warned that the threat to clinical engagement could leave other 'key implementation targets' at risk.
'While I generally support the changes, my main concern is that we have a lot of key policies which are dependent on close relationships with clinicians, such as choose and book and PbC, ' they commented.
'If we throw all of these in the air over the next few months we will start to risk the achievement of some key implementation targets.' Elsewhere, another chief executive warned that 'GPs are already turned off by [the policy]', while another insisted the reconfiguration of PCTs should 'follow the implementation of PbC not proceed it'.
Alliance bids to retain PECs NHS Alliance chair Dr Michael Dixon was due to meet with NHS chief executive Sir Nigel Crisp to make the case for holding on to professional executive committees in reconfigured primary care trusts, as HSJ went to press.
The meeting was held ahead of publication today of an alliance policy paper on the importance of clinical engagement throughout and after implementation of Commissioning a Patient-led NHS.
In it, the alliance warns that the policy could spell 'failure' for the modernisation of primary care as it 'may, in practice, lead to further disenfranchisement of clinical leaders from a strategic role in reconfigured PCTs.' The lobby group has moved to 'rebut the assumption' that the 'move to [practice-based commissioning] will remove the need for the PEC or any similar clinician grouping.' The paper warns that if 'some 3,000 clinician PEC members' currently working in PCTs are 'discarded from the system' the result would be 'widespread disillusionment and disengagement' and consequent 'failure of essential reforms'.
Chief execs on removing PCT provision
'The one area where we have made a real success is in improving our provider services, and this is being removed from PCTs.' 'Removing provider status from PCTs is ill-thought out and appears to be based on pure ideology. It is very high risk indeed.' 'The policy does not take a whole-system approach.
It seems like Tesco has written the approach to managing the integration and ground rules for contestability in the cornershop market.' 'Driven by the needs of foundation trusts.' 'The removal of provision is not thought through.' '[This will] hasten the demise of NHS care.'
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