Published: 28/07/2005, Volume II5, No. 5966 Page 5
The NHS has just over a year to reduce the number of primary care trusts by around half and slash 'at least' 15 per cent of 'management and administrative costs' to deliver the government's promised£250m savings.
PCTs will also be told to abandon direct provision of services unless no practical alternative can be found.
Speaking to HSJ after central guidance, Commissioning a Patientled NHS, was agreed on Tuesday, NHS chief executive Sir Nigel Crisp said new structures would require 'greater co-ordination' of PCTs with local authority social service boundaries.
However, he said this would not necessarily mean there would be 150 PCTs - the same number as social services departments - by the reconfiguration deadline of October 2006.
Sir Nigel repeatedly stressed the need for 'a clear relationship' between local authorities and PCTs.
But he said this 'does not mean 150' PCTs, as local factors may not make it practical for a PCT to be coterminous with a local authority.
He added that the white paper on healthcare outside hospitals, which is due to be published at the turn of the year, would also look at health and social care integration. Therefore PCT reconfiguration plans might 'need to be refined' after its publication.
Strategic health authorities have between now and mid-October to review their PCTs against the criteria set out in the document, and the Department of Health expects to agree proposals for PCT reconfiguration with each by mid-November.
Implementation - after a consultation period where necessary - can then begin and must be completed by October 2006. The guidance is clear that, once the reconfiguration is complete, PCTs should not be involved in direct provision of services unless 'no obvious alternatives exist'.
Sir Nigel said the aim was to ensure contestability in healthcare provision in primary, as well as secondary, care.
He told HSJ that the DoH would 'challenge' any PCT plans to continue providing services. 'They will need to demonstrate to us that there is contestability, ' he said.
But he acknowledged there might be instances in which PCTs would still provide services - such as if they needed to take over services from a 'failed provider', or if salaried GPs were needed to run a practice and 'there is not anyone obvious who would do it for you'.
However, if PCTs did have to manage services, they would have to ensure decision-making on commissioning and provision were separated, he emphasised. PCTs would be encouraged to consider provision 'from all sources', including foundation trusts 'if appropriate'.
SHAs are also being instructed to reconfigure so they align themselves with government office boundaries in most cases. Sir Nigel said he expected there to be 'nine-plus' SHAs by their April 2007 re-organisation deadline.
DoH draws up fitness tests for PCTs
The Department of Health has set criteria against which primary care trusts' fitness for purpose will be tested, including a requirement to ensure '100 per cent coverage of practice-based commissioning by no later than the end of 2006'.
This is in addition to the cost savings and becoming coterminous with local authority boundaries (see main story).
A second tier to the process will see an independent body test PCTs' leadership ability to cope with the challenges of dealing with payment by results and contestability.
The DoH says the process will be as rigorous as the tests applied by Monitor to aspirant foundation trusts, and will focus on strength of boards and governance.
www. dh. gov. uk