comment: Animosity between SHAs and PCTs threatens irreparable damage

Published: 24/10/2002, Volume II2, No. 5828 Page 21

It is hard to think of NHS Alliance chair Dr Michael Dixon as threatening. Bow ties and an interest in complementary medicine are not usually associated with warnings of bloody mayhem. But Dr Dixon was in no mood to mess about when he addressed the alliance conference last week (news focus, page 14). Strategic health authority chief executives who obstructed the work of primary care trusts would be 'writing their own suicide note', he snarled. Later, HSJ asked the health secretary, a visitor to the conference, to comment on Dr Dixon's threats. Mr Milburn made noises about SHAs needing to monitor some PCTs more carefully than others. He concluded that all concerned had got to 'learn the rules of the [new] game'.

SHAs - and their chief executives in particular - were the spectres at the NHS Alliance feast. Everywhere, optimism about the future of primary care was undermined by concerns over the 'outrageous' activities of SHAs. One SHA boss was described as a 'megalomaniac', another attacked for telling PCT chief executives not to discuss potential cost cuts with their boards, and nearly every authority was depicted as controlling and manipulative.

But let us, for a moment, look at it from the SHAs' point of view. They, too, are very new organisations - younger than many PCTs and with all the same staffing and strategy problems. They have been given a still-developing hands-off performancemanagement role in an NHS still much more used to, and in some cases comfortable with, a control and command model. Finally, SHAs report to the Department of Health's regional bodies, whose job is to ensure, by all means necessary, that national strategies get followed through at local level.

SHAs are a good idea - but the NHS is not ready for them. In a year's time, with PCTs surer of their ground, it might be. In the meantime, SHAs should attempt to find common cause with their PCTs - which might include suggesting that those at the top who cannot let go are playing a dangerous game. Managers could simply find a few GPs to say this on their behalf - much safer and probably more effective.