comment: PCTs may stuggle with their gargantuan role, but progress is being made

Published: 12/09/2002, Volume II2, No. 5822 Page 19

'There is a real sense that We are in the throes of a revolution, ' proclaims one of the primary care trust chief executives we interviewed for this week's issue (feature, pages 22-25).

But are we talking 1905 or 1917? Already there is talk of PCTs which are struggling to deal with a huge workload and lack of resources and experience (perceived or actual) being pushed towards merger. Some in the acute sector openly discuss how they will operate once the primary care focus is abandoned as a worthwhile, but futile experiment. GPs, too, complain that PCTs act like mini health authorities and that the influence and control they were promised (or experienced under fundholding or as part of commissioning groups) has now disappeared.

Within PCT management, as well, doubts abound. The job is too big, the resources too small, the control too tight, the targets too many, the space to innovate and reinvent services driven by primary care concerns almost non-existent. There is also, they claim, a failure to recognise that much primary care happens away from the GP surgery.

But progress is being made. The creation of professional executive committees has led some clinicians in primary and secondary care to communicate and innovate, and the development of more responsive, flexible and patient-centred services is beginning to make a real difference to health service users.

The majority of this progress is taking place in first or second-wave PCTs. The message is clear: give PCTs time to establish themselves and - all other things being equal - they can perform.

It is also welcome and significant that PCTs have created the opportunity for a group of health service managers who are younger, less male-dominated and with broader life and work experience than usual to make a mark on the NHS.

PCTs face myriad challenges - not all set by Mr Milburn - and their existence three years from now is far from guaranteed. But, for now, the revolution continues. l