Published: 04/08/2005, Volume II5, No. 5967 Page 5
The government's blueprint for primary care trust reform was this week slammed as 'incoherent', 'ill thought out' and 'an incredible way to treat important organisations' by senior NHS managers and policy analysts.
Commissioning for a Patient-led NHS - the document sent by NHS chief executive Sir Nigel Crisp to PCT, strategic health authority and social services chief executives last week - displays a 'complete lack of coherence' at the heart of policymaking, according to NHS Confederation policy director Nigel Edwards.
Mr Edwards attacked the document's directive that PCTs should - in most cases - stop directly providing services in order to ensure nonhospital care is contestable.
About 200 PCTs are currently 'substantial' providers of a range of community, primary and mental health services.
'If the message is that unless you're a locality commissioner or practice-based commissioner you can't commission and provide, this is intellectually incoherent, ' he said.
'There is arguably much more of a risk to contestability at locality or practice level, where it would be much harder to construct a Chinese wall [between commissioning and providing functions in the same organisation].' And he said it was vital that decisions on provision were taken locally.
A PCT chief executive, who asked not to be named, described the Department of Health's decision to push PCTs into abandoning direct provision as 'ill thought-out.
'It is much easier for me to maintain a wall [between commissioning and provider functions] than push out to practices when their salary will depend on take-up of their services.
'PCTs have much more of a vested interest in securing plurality than practice-based commissioners. This is just not thought out.' North and South Trafford PCTs joint chief executive Tim Riley said there were 'gaps' in the paper that need to be addressed by PCTs working directly with the DoH.
In particular, he said, it gave 'no real clear vision around what the model should be for the future of local provision'.
Mr Riley urged the DoH to talk directly to PCTs about their future role, adding: 'The jury is out on whether strategic health authorities are in a position to give a direct view as they are interested in configuration boundaries rather than ensuring confidence in local services.' John McIvor, Rotherham PCT chief executive and chair of the NHS Confederation PCT chief executive forum, welcomed the 'rider' in the DoH paper that managers should 'wait for the white paper for more on plurality of providers'.
'We are talking about 250,000 staff here, and we need to be very careful we do not disturb services in important ways in a rush to change PCTs.
Let's work out how to get transparency and contestability now, then look at the white paper to work out how we can provide those services in different ways'.
Bitter taste: how the news was broken
Some PCT chief executives are smarting at the way the DoH unveiled its intentions.
One, who has been closely involved in the primary care reform agenda, said they could not imagine 'how it could have been handled worse'.
'You do not use an email to tell important organisations they are going to have to make very radical changes.
'They also didn't send it to chairs, [and] we didn't get any kind of briefing. I do not know who has been lobbying the department to get this.
'Most of us are now saying: 'Who needs to work here?' if That is how We are treated, and asking if It is only the acute sector, yet again, who matter.
'It is left a very bitter taste in the mouth. I am going to find it very hard to defend to staff because we haven't got an answer to give them.'
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