comment: Apparently political motives see the centre eroding a PCT's autonomy

Published: 03/06/2004, Volume II4, No. 5908 Page 15

Two years in, the pressure seems to be building on the primary care-led structure of the NHS on a week-by-week basis. Reports that NHS chief executive Sir Nigel Crisp walked out of an interview with the BBC will add to the disquiet.

As we report this week (pages 4-5), the cause was the allegation that South West Oxfordshire primary care trust was forced to sign a deal with a private sector company that - originally at least - it decided it did not want. It is ironic that the Department of Health is putting so much effort into developing the ability of non-executive boards (feature, pages 30-31) when it seems so belligerent towards this particular one showing its own independence.

It is not clear if the national ophthalmic chain contract agreed with Netcare depended on every single local PCT buying into it - but the centre's reaction suggests it did. Was this really about what was best for patient care rather than how good a united front would look politically? Although in this case the knuckledusters seem to have been handed to the strategic health authority, it was the centre that stood to gain by reversing the PCT's position.

There is nothing in the allegations this week, or the many in previous weeks, that suggests the primary care structure is inherently flawed. As Dr Barbara Hakin argues elsewhere (Ideas, pages 16-17), its achievements have so far been trumpeted too quietly. But managers in the centre are undermining that work if they run roughshod in such an obvious way over local autonomy. No-one is naive enough to think there will not be some pressure put on PCTs, but agreeing the terms of a national deal first and asking questions locally later seems guaranteed to make a mockery of the process. l