Karen Bell

1983-87 Unit personnel manager, and acting district personnel manager, Cambridge health authority

1987-92 Director of personnel, Cambridge city council

1992-99 Human resources director, Lifespan Healthcare trust

June 1999 to date Chief executive, Huntingdon primary care group

Chair, Anglia and Oxford branch of AHHRM

It is historical accident rather than deliberate policy that has led human resource managers to elect a primary care group chief executive as their figurehead.

Karen Bell was already president-elect of the Association of Healthcare Human Resource Management - whose conference takes place at Warwick University this week - when she took up her new job in June as chief executive of Huntingdon primary care group.

But having a PCG chief executive at the helm, she thinks, reinforces the idea that the whole issue of HR in primary care is one that has to be taken very seriously by AHHRM.

'Primary care, because of the way it has been organised, has had very little HR or organisational development input,' she points out.

But the potential for 'joining up' primary care with community and secondary care will require HR and change management input, she says.

She is already demonstrating how that can be done in her new role as a PCG chief executive, a move which follows an HR career in health and local government spanning more than 15 years.

Her own PCG serves a population of more than 150,000, with a unified budget of around£85m, in an area of predicted population growth. The group consists of 24 practices with 84 GPs, and their patients use around 85 per cent of the hospital and community services provided by Hinchingbrooke Health Care trust.

She sees some of the difficulties in ensuring that the NHS agenda for HR is incorporated into future primary care management as rooted in the 'artificial barriers' separating primary from community and secondary care.

Ms Bell is well aware that meeting minimum HR standards is crucial to the transition from PCG to primary care trust status. Indeed, without meeting the criteria set out in an NHS Executive circular last month, proposed PCTs will not be allowed to proceed.

She is a member of the group set up by the NHS Executive to produce further guidance - due out in November - on HR for PCTs.

She points out that they will be 'employing a lot of staff', making it vital that they are signed up to the government's agenda, as set out in the framework document Working Together. HR is definitely not a soft option, she says - a lesson that was undoubtedly reinforced in her previous job at Lifespan Healthcare trust. She was deeply involved as executive director of human resources in negotiations on a 25 per cent cut in children's community services, which led two years ago to school nurses being abolished and reductions in health visiting.

The trust's own review has found that these cuts have damaged public health, with community staff stretched too thinly to give families the support they need (news, page 4, 9 September). Cambridge HA has now reversed more than a third of the changes and the trust is reviewing what it should do.

None of this surprises Ms Bell, who says that at the time 'we argued very hard against the cuts and we also offered alternative ways of achieving savings'. But there was also a view that the lower-risk end of health visiting was manageable in other ways.

'I don't know that anybody at Lifespan thought it was a good idea,' she says.

Removing all low-risk work did not necessarily mean that people would be free to take on the more high-risk cases, she says. And she is indignant at the thought that Lifespan should be publicly known more as a cutter of health visiting than as a progressive unit.

'Looking back on my career so far, Lifespan was the most committed to learning and organisational development and supporting staff - it is a very innovative trust and very empowering,' she says.

She acknowledges that working to help managers deliver the new HR strategy throughout the NHS is one of the key challenges facing AHHRM. But she says the timing is perfect. 'The challenge is to accept the opportunity because the climate is there, the policy is there. In a sense, there is nothing to stop you other than your own ability to convince your own organisation.'

It does demand a culture change, she says, and there will be difficulties in persuading some managers of the need for family-friendly policies, for example. But they should look to the private sector, which invests in HR not from altruism but because it leads to greater profit.

'We cannot recruit key personnel in specialist areas and that problem is going to get worse,' she says. 'One of the reasons why there is wastage is the lack of family-friendly policies.'