this week

Health improvement programmes 'may not be worth the paper they are written on' because of low levels of input from primary care groups, PCG representatives have warned.

HImPs were rushed out this month after huge effort by health authorities to produce the local health plans within the six- month timescale set by the government. But PCG representatives claim their involvement has been nominal.

Maggie Marun, a management consultant with the National Association of Primary Care, said: 'You'll have to search far and wide to find the impact of HImPs.

'I don't think PCGs have really been involved this year. The timing was disastrous - PCGs were scarcely in shadow form when this process began.'

The NHS Primary Care Group Alliance also warned that HImPs' effectiveness this year would be severely limited.

'In the majority of cases, HAs have gone ahead and completed their HImPs without proper engagement of PCGs,' said chief officer Michael Sobanja. 'It will cause practical difficulties because PCGs will be key players in the delivery of HImPs. If PCGs aren't fully engaged in the process, they won't be worth the paper they are written on.'

The HImP process is intended to establish local priorities and tackle inequalities through joint working by the NHS, local authorities and other agencies.

Mr Sobanja said some were overly ambitious and vague: 'There is some nuts and bolts stuff but others are a bit 'pink fluffy clouds in the sky'. They have to be grounded in reality so people can relate to them.'

Despite their criticisms, PCG representatives said they believed in the value of HImPs.

Michael Dixon, chair of the PCG Alliance, said PCG involvement would increase. And he was 'very optimistic' that HImPs would succeed in extending the reach of healthcare.

HA managers and public health directors who co-ordinated the HImP process insisted they had been invaluable in furthering joint working. Linda Ewles, public health specialist at Avon HA, said the 'absolutely mammoth' effort involved in producing its 180-page HImP had already paid dividends.

'It's been a good vehicle for setting up new partnerships. We've had GPs sitting in the same room as people from social services for the first time.'

The greatest progress in HImPs appears to have been achieved in areas with health action zone status, traditions of joint working and strong GP commissioning.

Bobbie Jacobson, director of public health at East London and the City HA, said the HAZ would become the 'action arm of the HImP'. She added that the HA had held 'very useful discussions with the other stakeholders, particularly with community trusts and PCGs'.

Dr Jacobson said developing the HImP had been 'tremendously time-consuming but very rewarding'.