What's on managers' minds this week

Published: 01/04/2004, Volume II4, No. 5899 Page 14

If There is one issue bothering primary care trust chief executives, It is everything. If it is not the new GP contract, it is would-be foundation trusts 'bullying' PCTs.

Then those PCTs that commission from foundation trusts are having to deal with the implications of payment by results, and those that are not say that effective commissioning is a huge challenge anyway.

One London chief executive says: 'As soon as we get a handle on one initiative, another comes along and We are told It is a must-do.We can only cope with so much.'

A chief executive in the North says he doesn't have a problem with most of the changes, but he does regard much of the implementation workload with horror: 'We'll get there in the end, but the centre has under-estimated the amount of work we will have to do.'

The new GP general medical services contract is throwing up a host of problems, managers admit, especially arranging enhanced services.

One senior manager likens the difficulties to the problems in funding the consultants' contract (news, pages 3-4, 19 February).He says noone quite realised how much work GPs did, and now that it is being analysed and costed it is leaving PCTs with a much bigger bill than they anticipated.

Ensuring 24-hour access to health professionals, and 48 hours for a GP, also sits on PCT managers' checklists. One manager describes the targets as 'essentially political, not clinical' and confesses that some methods used by practices to hit the target are 'pragmatic'.

The best news that PCT managers have had so far this year, they say, is the announcement of the eventual shift away from the existing approach to performance measurement being led by the new Healthcare Commission, successor to the Commission for Health Improvement. One manager describes the current star-rating system for PCTs as 'completely devalued'.

He says that while no-one wants to be zero-rated, beyond that his team would be content as long as they knew they were doing a good job, irrespective of their rating.

One Midlands PCT senior manager suggests that not only is there pressure on PCTs to sign up to legally binding contracts that would benefit foundation trusts more than the PCTs (news, pages 3-4, 18 March), but that foundation trusts are also flexing their muscles to achieve vertical integration of services, while his PCT wants to spread horizontally.

As his PCT attempts to work more closely with social services, he says the local foundation applicant is loath to offload services to primary care.

A less widely publicised requirement this financial year is the duty for PCTs to co-operate with their local police force on crime reduction strategies (law, page 41, 25 March). One London PCT manager, responsible for implementing the strategy, suggests that despite ministers' promises, no money has been forthcoming and the plans have slipped to the bottom of the priority list.

Another concern is clinician engagement. One manager says his PCT has had a professional executive committee vacancy for six months, and unless money is provided to fund locums for GPs carrying out PCT work, there will be no improvement in the level of engagement, which they argue is already low.

Take your pick, but PCT managers have plenty on their plate, although it may not be the only the headline-grabbing issues that are worrying managers. A quick trawl of the National Primary and Care Trust Development Programme website message board suggests that a strategy for records management would be top priority for PCT managers. A thread on the topic has been viewed an incredible 80,000 times.