Consultation on PCGs' bids for trust status ends this month. But will PCTs generate the public interest their predecessors have lacked? Mark Gould reports

It would be a tricky brief for an advertising agency: fledgling organisation with zero public image seeks mandate to turn into something else.

But that is about the size of the task 19 primary care groups have been trying to overcome as they consult on their bids for primary care trust status in the first wave going live from April next year.

If that wasn't enough, the British Medical Association is demanding that any trust proposal must have the blessing of two-thirds of local GPs in a ballot with a minimum 80 per cent turnout.

Consultation ends this month. So is England alive with talk of PCTs? Are unions and professional groups happy with the ramifications of what will be a merger of community trusts with PCGs and a new style of employer? And is the pace of change too fast?

Eleri de Gilbert, chief executive of Mansfield PCG, calls the timetable for consultation 'condensed rather than rushed'.

'We had always argued from the very start of the PCG that we set out with the intention of becoming a trust, so I think trust status is not something that nobody knows about, ' she says.

Ms de Gilbert says she has hosted 34 meetings within the last three weeks - from small groups to more than 150 people - to explain the bid and get feedback. Local newspapers and radio stations have run positive stories about the change.

'We have been to the community trust, the voluntary sector and even had a meeting at the local acute trust to talk to consultants about what the changes will mean for them. The feeling that I have got back is that there is pretty much a consensus for trust status although people are worried about the pace of change.'

Ms de Gilbert says Mansfield PCG has been working closely with its local medical committee. 'We did not want to have a ballot with a simple yes-no answer so we decided to carry out a survey instead, ' she explains.

Poole Central and North PCG and Poole Bay PCG have yet to start their formal consultation exercises, but PCG chief executives have already been out on a series of roadshows telling people how PCGs and PCTs can better address local health needs.

Dorset health authority spokeswoman Pauline Chudleigh says: 'The public perception of what PCGs are about is beginning to come through, and people are seeing that nurses and doctors are there to improve local services.

'When PCGs first started we had people coming in or ringing to ask if they would have to go somewhere else to see their GPs.'

Southampton East Healthcare PCG hopes to convert to trust status in April, but Dr Bob Button, secretary of Southampton LMC, says 75 per cent of the 79 GPs in the PCG want it deferred.

'We think PCGs are barely out of nappies. GPs have difficulty understanding the concept and they have a crucial role to play, so I can't think what the general population thinks.

'PCGs haven't even completed one financial year yet and they want us to change into something with a freestanding board, a massive human resources agenda and integrating with community services - and do it all within three months.'

Dr Button says October, or even April 2001, would be a more feasible start date.

Three PCGs in East Anglia - Fenland, Peterborough North, and Peterborough South - are going for trust status. Bill Williams, corporate services manager for Peterborough North PCG, says the consultation has been presented as a new chance for a local focus following a large HA reorganisation.

'The HA headquarters were moving from Peterborough to Huntingdon, so there was a perception that decision making was becoming more remote.

The PCT would be a way of creating local decision-making groups.'

He is happy that the public and professionals have been involved from the very start and that the question of prioritising services has been made clear.

'The rationing question has not come up in any debates we have had but we have made it clear that where we have to prioritise services we would have to do it working with the public, ' says Mr Williams .

The PCG has visited every GP surgery, and met community staff groups, representatives of various hospital-at-home schemes, night nurses, professions allied to medicine and the voluntary sector 'who will have a big role to play'.

Royal College of Nursing community health adviser Lynn Young agrees that consultation on the April wave has been patchy, and is disappointed that the British Medical Association wants veto rights.

'This is a brand new project. It's not just a reconfigured community trust - it's an all-new community organisation. Everyone should have their say and the dialogue must be meaningful.'

Roy Paterson, Unison national officer for primary healthcare, says summer guidance on trust status called on every local employer to set up a forum in which trade union representatives, HAs and community trusts could come together. 'Some PCGs have made the effort to involve staff at an early stage, but in other cases we were only made aware of trust bids at the 11th hour. It has been patchy.

'We are certainly looking for better consultation from the October applicants for trust status. They have no excuse that they haven't got time to do it.'