PRIMARY CARE Concern among unitary authorities that coterminosity will be lost in reconfiguration

Published: 18/08/2005, Volume II5, No. 5969 Page 6

Unitary authorities fear existing partnerships with primary care trusts could be set back if PCTs already sharing council boundaries are merged.

Last month, NHS chief executive Sir Nigel Crisp set out plans to cut management costs in primary care by 15 per cent. He said the aim was to 'reconfigure PCTs to have a clear relationship with local authority social services boundaries'.

But his document Commissioning a Patient-led NHS said there could be exceptions to this rule. Crucially, it says: 'This does not mean a rigid 1:1 coterminosity - big local authorities might have more than one PCT, whereas a number of small unitary authorities might fit into one PCT.' The majority of England's 47 unitary councils combine the functions of county and district councils and usually serve large towns and small cities. Most already share boundaries with their local PCT.

This week, HSJ's sister title Local Government Chronicle reveals that 79 per cent of unitary authorities taking part in a survey fear the pressure to make management cost savings could see coterminosity sacrificed.

Thurrock council chief executive David White surveyed his peers working in unitary authorities and found that 15 out of 19 chief executives were concerned that shared boundaries would be lost.

Mr White, whose council has set up joint teams for older people and employed a joint director of integrated services with Thurrock PCT, fears for the future of similar projects.

He said: 'There could be a tendency for strategic health authorities not to pay due regard to coterminousity of small unitaries. This would be a retrograde step.' Mr White said he feared losing coterminosity and having to review existing joint posts.

Many unitaries have already embarked on pioneering partnerships with their local PCT in public health, children's services and adult social care. The future of officers employed jointly by the two organisations is now uncertain.

Medway Council chief executive Judith Armitt said: 'We have had a coterminous PCT for three years. It is working brilliantly and we are seeing a lot of benefits.

'There is concern about reducing overheads in the NHS, but the risk is that the baby will be thrown out with the bathwater.' Kent and Medway SHA is already examining a number of PCT merger proposals, some of which would see Medway PCT subsumed into a larger organisation covering the Thames Gateway. Ms Armitt fears such proposals cast doubt on existing joint projects to support disabled people living in the community, and progress towards establishing a children's trust.

'Medway would join up with part of Kent county council's area. I think there would be a much more confused picture in terms of how services responsive to the needs of the local population would be commissioned, ' she added.

Darren Grayson, chief executive of East Kent Coastal PCT and PCT chief executive lead for the Kent and Medway fit-for-purpose review, said no decision had yet been taken about the shape of PCTs in Kent and Medway.

And he said close relationships between PCTs and the councils would continue to be central, 'whatever the final outcome' of the review.

NHS Confederation policy manager Jo Webber said: 'As a rule it is easier for PCTs to only have to work with one authority.' PCTs in London were keen to maintain coterminosity, she added.

But Ms Webber said there was a balance between the benefits of localism and the ability to make cost savings via bigger organisations.

She said large PCTs 'will not definitely be a bad thing, as long as local structures are maintained'.

Miss Webber urged local partnerships to make their views plain to SHA planners. She told HSJ: 'It is still all to play for. The SHAs' final plans do not have to be in until midOctober. Local partnerships need to be telling SHAs that what that they are doing is working. And PCTs need to say to SHAs: let's not throw out what We have learned and the relationships We have made.'