Managers fear year of policy confusion as primary care groups are established

Research carried out with the Healthcare Financial Management Association has revealed an urgent need for detailed guidance on the structure and finance of PCGs if they are to be in place by 1 April next year.

Responses from more than half of all health authority finance directors also show concerns about GP commitment, resources and workload.

One in five of the finance directors who responded to the survey said the huge PCG agenda meant a danger of HAs taking their 'eye off the ball' on other management issues.

HFMA chair Jaki Meekings said: 'The main message is that people need guidance quickly. Unless we get some of these issues clear, policy failures could be seen as management failures next year.'

The survey was returned by finance directors from 51 of the 100 HAs in England.

Just over 40 per cent were 'wholly' in agreement with the 'vision and direction of travel towards PCGs' while 53 per cent were 'moderately' in agreement.

Forty-seven per cent said it was 'proving easy' to get GPs on board in their areas, while 39 per cent said it was proving difficult.

The survey asked what could have been done nationally to help HAs get doctors involved. The most common suggestion was 'earlier, consistent guidance' telling everyone what is involved.

But there was also a call for more leadership from national organisations such as the British Medical Association.

After initially backing The New NHS white paper, the BMA's general medical services committee has threatened the government with unspecified action if it does not make concessions on the control and financing of PCGs.

The committee is meeting ministers for talks about the demands today.

The survey suggests that implementing the reforms will be expensive.

Two-thirds of the finance directors who replied estimated the 'additional costs associated with setting up a PCG' would be up to pounds200,000, although a quarter thought it would cost more.

Almost 80 per cent had not identified the money in their budgets.

The survey was sent out before the government announced how it was allocating pounds22m for PCGs to HAs.

Sixty-three HAs have been allocated less than pounds200,000 and 18 have been allocated less than half this sum.

More than 60 per cent of finance directors surveyed thought PCGs would cost more than existing commissioning systems.

But most also thought they would make no 'major changes' in the pattern of commissioning. A minority felt there would be shifts over time. A number of finance directors said this was inevitable, given the uncertainty about the future shape and funding of PCGs.

'All our efforts will be directed at getting the information in place. We must have steady state in 1999-2000,' said one.

'We are advising potential PCGs that we would expect steady state to be in force in 1999-2000 given the uncertainty about allocations to PCGs,' said another.

The survey also showed that despite fears about management job losses, only 24 per cent of finance directors have noticed any increase in staff turnover rates since the publication of The New NHS white paper.

See News Focus, page 12 and Comment, page 17.