Published: 07/10/2004, Volume II4, No. 5926 Page 16
As the choice agenda looms ever larger, 'choose and book' is the latest policy to deepen the furrows on the brow of primary care trust senior managers.
Some are furious at what they see as the political impetus driving the December 2005 deadline for the policy to provide booked appointments alongside choice at the point of referral. They believe the government's desire to make the policy a so-called 'early deliverable' following a general election is guiding the timetable ahead, and that the rush to implementation means vital infrastructure may not be in place in time.
'It seems to me it is fast becoming an idiocy because there is a political requirement to do this, but nobody has thought through the risks to outpatient waiting lists, ' says one London PCT chief executive.
'The electronic means to implement the policy is not in place so far, and there is little prospect of it being ready in the timescale. People are saying we will have to do it manually at first - what kind of stupidity is that? That would mean lost referrals, no follow-up, no central tracking or control, which all add up to patient safety risks - It is all bonkers.'
However, a northern PCT chief executive is more hopeful about the process and suggests that good IT planning at local level can help to remove some of the sting. 'The IT systems always lag behind the reform thinking, but I am wholly convinced It is the right thing to do and it will be easier where centralised booking systems have already been put in place.We just have to prioritise this because once we can book the patients we can take the waiting out of the system.'
Practice-led commissioning is is largely being welcomed by PCTs, but whether devolving budgets to GPs should be used as carrot or stick seems to be open to local interpretation.
For example, one London PCT chief executive is planning to offer its practices the chance to enter negotiations only if it has scored above a certain threshold on its quality and outcomes framework (QOF) scorecard for clinical indicator results.
This may seem entirely sensible, but a northern counterpart is not convinced: 'I would be slightly cautious about using the offer of [practiceled commissioning] as an incentive for people to improve their QOF performance because you might want to encourage the less successful practices to take it up as part of an overall strategy to improve.'
Anxiety about budgetary control, commissioning and whether PCTs have the means to cope still dominate senior managers' operational inboxes.
A PCT chief executive in the South East is reeling after replies to a letter they sent out to specialist service providers requesting information on their spend started falling on the mat last week.
'Basically the whole of the SHA is destined to overspend by£4m [on specialist services] this year.'
This chief executive wants to put in a plan to bring this commissioning - which represents up to three-quarters of their budget - in-house, which requires 'beefing up' the commissioning team from a non-existent pool of skilled middle managers. 'We need to grapple with the PCT middle management problem.We have got good directors and wonderful people on the front line, but sparse talent in middle management. All the effort on training leaders is misplaced.'
Another northern PCT chief executive disagrees, arguing that PCTs should focus on recruiting and training clinical leaders, and removing their 'task-driven blinkers' to reveal the wider picture. 'We have invested very heavily in clinical leaders. It is true middle management skills do not exist, but rather than having more folk like me we need to get change from buy-in and engagement from clinicians.
'There is a lot of management-bashing around. But if we respond as bureaucrats, we deserve it.'