EXCLUSIVE GP involvement in NHS reform programme is being put at risk, survey reveals

Published: 06/10/2005 Volume 115 No. 5976 Page 5

Hard-won clinical engagement with GPs, nurses and allied health professionals will be destroyed by the 'politically driven' reorganisation of primary care trusts, clinical leaders are warning today.

Four out of five PCT professional executive committee chairs say the current reconfiguration process would weaken or seriously weaken GP engagement with the NHS and its priorities.

An even higher number (86 per cent) say the reconfiguration outlined in the Department of Health's July policy paper Commissioning a Patient-led NHS would damage engagement with nurses and AHPs.

The joint survey of 102 PEC chairs by the NHS Alliance and HSJ asked for their views on the impact of the reconfiguration.

Over three-quarters said that 'local circumstances and patient needs' were not getting proper consideration in the reconfiguration processes.

Worryingly for the government, 59 per cent believe the implementation of practice-based commissioning would be disrupted by the reconfiguration. PECs have been at the forefront of selling the idea of practices holding indicative budgets under PBC.

The DoH wants all practices to be participating by the end of next year, but around 50 per cent of survey respondents said fewer than half of practices in their local health economy would be signed up to PBC by the government's deadline.

Meanwhile, more than half of the clinical leaders surveyed (58 per cent) said patient care would suffer as a result of the 15 per cent management and administration cuts each organisation is expected to find through the reconfiguration process.

'This reorganisation feels much more 'politically' driven and less 'bottom-up' or clinically driven [than previous commissioning restructures], ' said one PEC chair.

'Currently, the PCT has a locally accountable management team focused on local health needs; I can't see this being sustained in a bigger PCT with reduced management costs, ' he added.

'I am not condemning PBC...just struggling to understand how this reorganisation is going to achieve it.' Commenting on the survey, NHS Alliance chair Dr Michael Dixon said: 'If we fail to pay attention now to the significant concerns this survey has highlighted, we could seriously damage the ability of the NHS to deliver the reforms the government intends and the Alliance supports.' Dr Dixon called on the DoH to review the proposals. 'Of course we need organisations that are fit for purpose, but this does not mean that we should rush headlong into a one-size-for-all approach, ' he said A DoH spokesman said: 'Far from weakening clinical engagement, our plans will mean that clinicians have a leading role in deciding what services are commissioned locally, to suit the choices their patients are making.

'This means that GPs will have more say on their patients' behalf about how health services are designed and delivered. We think this will release fresh ideas and stimulate lots of innovation about how services are run.'

Nurse leaders voice their concerns Department of Health workforce director Andrew Foster is due to attend an emergency summit today to hear nurse leaders' concerns over the impact of the reconfiguration of PCTs.

The summit was convened by the Royal College of Nursing after increasing numbers of its senior members - such as directors of nursing - voiced concerns over the Commissioning a Patientled NHS policy.

RCN director of service delivery Janet Davies said the union would use the summit to inform its work around the reconfiguration on its members' behalf, in particular finding out if nurse leaders were being involved and had a clear understanding of the strategy behind the changes.

She told HSJ the meeting would give her a clearer idea of what plans were being developed over the future of provision of primary and community services and how this was likely to affect nurses' recruitment and retention.

See Feedback, page 18.

For full results of the survey of PEC chairs, visit www. hsj. co. uk