Make history or die, PCTs told

Primary care trusts have just two years to 'make history, or become history', the NHS Alliance has warned.

Alliance chair Dr Michael Dixon (pictured) told last week's conference in Bournemouth that unless PCTs proved they could deliver before the general election their time could be up.He said the key to success was to get clinicians on board.

A study produced by the alliance has found that strategic health authorities' engagement of primary care clinicians varies hugely.Many PCT managers feel that SHAs have a poor understanding of primary care and that primary care clinician input is absent or tokenistic.Dr Dixon said: 'I give the centre and SHAs just one year.One year in which to support, to encourage and to empower PCT managers, clinicians and lay people to take the full reigns of responsibility for their local population.They have a year to end centralism in the NHS, to ensure that primary care matters and the voice of involved primary care professionals is heard at every level.'

'How can we talk about new localism when all I hear about is 'top tables'where the important decisions are made? Where are the PCTs at this top table? Where are the clinicians? How can we say they are in the driving seat when they hardly feature at all in SHAs or at the centre?'

NHS chief executive Sir Nigel Crisp accepted that there were difficulties between some PCTs and SHAs, but he said it was 'not surprising at this stage'. He said much of the relationship depended on the strength of the local health economy. 'If you work in one of the most challenged areas, you need to work together. If you work in - dare I say? - Avon, Gloucestershire and Wiltshire, you have to ask what you can do for the whole NHS in that area, rather than your individual organisation.'

Last month health minister John Hutton announced to the National Association of Primary Care that personal medical services pilot schemes would become permanent and that PMS contracts would not be 'unpicked' following the announcement of the new general medical services contract.

Thought to be a tacit acceptance that the PCT structure was not working as well as hoped, PMS practices are to be given greater freedoms and encouraged to work as commissioning agents of PCTs where they want to. PMS providers will also be given greater control of their practice budgets and allowed to develop local variations of the new GMS quality framework.

Dr Dixon said that although some people had an attitude of 'we have messed up PCTs, let's go to the lifeboats', it was important for PCTs to persevere. He accepted that there should be no more structural change, but he said the roles and relationships of PCT boards, management executives and clinical executive needed to be re-examined.