Published: 17/04/2003, Volume II3, No. 5851 Page 30 31
Teaching PCTs were intended to improve the range and quality of healthcare in 'underdoctored' areas. But if they are to continue their work, the cost will have to be met from existing resources.With 11 new teaching PCTs due to begin work this month, Neil Small and Lynn Stinson assess their worth
In March 2001, when prime minister Tony Blair announced the government's intention to establish teaching primary care trusts, he pledged an allocation of£25m over three years. It was clear that this was a practical initiative which aimed to improve the range and quality of healthcare in targeted areas.
1,2 Their establishment reflected widespread concerns about recruitment and retention of primary care staff in areas considered 'under doctored'.
The first three - Bradford City, Salford and Sunderland - started work on 1 April in the same year. Two years on, what has been achieved?
Eight more teaching PCTs were established in April 2002 and 11 more begin this month.
3Last month the Department of Health confirmed that targeted invitations had been issued to 10 further sites inviting them to submit proposals to be fourth-wave teaching PCTs beginning in April 2004.Although the number to be established is not known, given the teaching PCT outreach remit, a likely scenario would see one within each strategic health authority.
The three first-wave teaching PCTs developed slightly different organisational visions and practice priorities.
Bradford teaching PCT's priorities were recruitment and retention of more GPs, the development of personal medical services pilots and the recruitment of more practice nurses.Other aims were to increase the number of training practices and develop city-wide - as opposed to practicebased - training, to improve chronic disease care, and to develop welfare advice and counselling in practices. The development of a community approach to mental health was another priority.
Eighteen GPs have been recruited via a scheme where they are employed by the PCT and have a combination of portfolio career development and supportive mentorship. Eleven of these have moved on from the scheme and taken up posts in Bradford, nine within Bradford City PCT. Seven others are currently on the scheme, with two more about to start. Each GP has worked in two practices and had two identified support sessions a week.
Support sessions can be used for teaching, audit or research activity and provide an opportunity for new recruits to discuss practice and professional issues with the project lead, an experienced GP trainer.
4A similar scheme targeting dentists is in development and one for nurses began with the appointment, in February 2002, of a senior nurse to co-ordinate a portfolio career scheme.Other initiatives in relation to nursing have included the establishment of a support team to offer short-term support where a practice has recruitment problems to cover for sick leave, holidays and study leave. The team consists of nurse practitioners, four practice nurses, 10 staff nurses and two healthcare assistants.
Other achievements include the appointment of seven healthcare assistants. Thirty GP practices now provide welfare rights advice and counselling.
Until the end of November last year, 2,198 clients had been seen and approximately£1,754,799 had been raised in benefits.
5Changes in mental health services include the establishment of the city therapeutic resources team for those with mild to moderate mental health problems.
The team, which is made up of workers trained in counselling or art therapy, received just under 1,400 referrals in its first year. Bradford University's department of citizenship and community mental health has been set up under the leadership of two consultant psychiatrists. City-wide support for the education of medical students has been developed via the appointment of an experienced GP as lead.
The teaching PCT budget is nonrecurring. Department of Health guidance indicates that long-term costs of continuing to operate as a teaching PCT will be met from resources currently available - that is, from the unified budget, the training and education levy and the research and development levy. The relevant trust boards will have to decide if this is an area that they wish to sustain amidst competing claims for finance and management focus. They will want to know the value added. This will require evaluation.
As second and third-wave teaching PCTs develop, there may be advantages in comparative study of the different organisational models and priorities they pursue. It seems that different local needs and preference are stimulating original ideas.
Haringey teaching PCT in north London is developing UK accreditation qualification pathways for refugees and asylum seekers. Lincolnshire South West teaching PCT has an NHS primary care cadet scheme for sixth formers and mature students.
Teaching PCTs have been set an agenda relating to recruitment and retention.They have a key contribution in developing a learning environment both in their own organisation and their local health community. In doing this they are consistent with the spirit of the modernisation agenda and the overall ramifications of Shifting the Balance of Power. Sustaining the innovation when the initial pump-priming funding has concluded will be a fundamental challenge for teaching PCTs.The forthcoming ministerial review of PCTs' role in education, learning and research will be critical.
So, too, will be future funding decisions. Last month we learned that over the next three years almost£12m would be allocated to teaching PCTs.
This will be used to give second-wave sites funding for a second year and to give funding over two years to the third wave in 2003-04 and 2004-05 and fourth wave in 2004-05 and 2005-06.
While this confirms the government's commitment to the development of teaching PCTs, it represents a reduction in the ringfenced allocation of funds. It appears that these teaching PCTs will have to rely more on funding being allocated by their host trust boards and it calls into question the ability these, and any future teaching PCTs, will have to approach their agenda in as wide a way as has been evident in the first wave.
Two years on: achievements in Salford and Sunderland teaching PCTs
Creation of a directorate infrastructure supporting teaching and learning activities.Twenty support staff in post.
Provision of library facilities and an e-learning suite.
£2m of income raised for teaching and learning activities.
Development of joint posts in public health (Manchester University) and prescribing (national prescribing centre).
Supporting salaried GPs to undertake research and development and learning.
Increasing training practices from four to 12.
Sevenfold increases in primary care staff accessing NVQs/ILAs (currently 72).
A fivefold increase in research and development.
Research management and governance site for eight PCTs.
Development of integrated knowledge management services across Salford and Trafford with equitable access for all NHS employees and independent contractors.
PCT pilot for Greater Manchester Delivering the Workforce projects.
e-learning modules in primary care for consent, manual handling and infection control.
Greater corporate consistency ensuring training and learning is strongly linked to organisational development and clinical governance via personal development plans.
Research facilitator to build capability in PCT to prepare for PCT research management and governance.
Secured investment of£300,000 to double the number of teaching practices in Sunderland.
Facilitated higher professional development programme for new GPs in Northumberland, Tyne & Wear.Thirty have completed this.
Partnership programme with local schools, including mentoring and work placement to encourage 14-16 year-olds to seek a career in the NHS.
Career Start for GPs and nurses - nine GP and three nursing places.This is a salaried scheme, including two sessions per week of protected learning time.
List sizes reduced from an average of 2,220 to 1,918.
Single-handed practices reduced from 19 to 11.
Focused partnerships with local universities: Northumbria - needs assessment for older people, Sunderland - chronic diseases, coronary heart disease.
Pilot site with NHS University for First Contact training, including nurse practitioners.
Advanced practitioners: target across for 33 practitioners, validation by Newcastle University postgraduate centre.
Primary care GP Choices scheme to address retention.Twenty-nine new GPs have started work in the city since teaching PCTs have been established.
Joint approach across Northumberland, Tyne and Wear to GP appraisal.Forty-one trained GP appraisers in place.
Returner's scheme - wage paid during 10-week period for people who otherwise would not be able to take up training.
1Department of Health, The Bulletin. Issue 3, May 2001. www. doh. gov. uk/gpbulletin 2Department of Health.
Teaching PCTs. 2001 3Second-wave teaching PCTs were Blackburn and Darwen; Bristol North and Bristol South and West; Haringey; Heart of Birmingham; North Tees; Slough; Luton; Lincolnshire South West. Third wave are City and Hackney; Portsmouth and City; Greenwich; Plymouth; Bournemouth; Eastern Hull and Western Hull; Coventry; Walsall; Stoke; Merseyside; North Peterborough Confederation (North Peterborough, South Peterborough and Fenland).
4 Dickson P, Greasley P, Small N. The Bradford salaried non-principal scheme. Primary Health Care Research and Development 2002;3:85-95.
5Greasley P, Small N. Take it from here. HSJ 2002; 112(5795)28-9.
The first three teaching primary care trusts, which came into operation in April 2001, have increased recruitment of GPs and practice staff.
Sunderland PCT has reduced practice list sizes as a result of the initiative.
Salford teaching PCT has tripled the number of training practices.
Eighteen GPs have been recruited in Bradford.
Neil Small is professor of community and primary health, Bradford University. Lynn Stinson is head of Bradford City primary care teaching trust.