'Democratised'PCTs in the pipeline

Primary care trust boards could face a shake-up as the government examines ways to 'democratise' them to balance the new structures proposed for foundation hospitals.

Health secretary Alan Milburn has indicated that he would welcome greater local autonomy and accountability for PCTs, but has also acknowledged that the relatively new bodies are still finding their feet amid huge changes in their workload.

A Department of Health spokesperson confirmed: 'He can see elections to PCT boards, but they will need time to bed down.'

The spokesperson added that no work was being done on new structures for PCTs and plans were merely 'aspirational'.

But HSJ sources say discussion is going on around a number of options, including increasing local government representation and changing the balance between lay and professional board members. The debate is understood to be wide ranging at this stage.

It is believed that the governance arrangements proposed for foundation hospitals - where members of the bodies to be established as 'public benefit corporations' will elect a board of governors who will in turn choose non-executive directors - has sparked attempts to ensure PCTs are similarly 'democratised'.

But one government source played down suggestions that anything concrete was being planned, stressing that PCTs would still 'be guided by national priorities for funding and purchasing'.

Although there were a number of ideas that were 'worth debating in making sure PCTs are sensitive to local preferences and priorities', a return to the days when local councillors were on health authority boards was unlikely, he said.

In the wake of the 2002 Budget, Mr Milburn said that foundation status may eventually be extended to primary care trusts.