Published: 07/04/2005, Volume II5, No. 5949 Page 8

Primary care trusts have shown 'enterprise and innovation' in designing joint management structures that allow them to combine forces while maintaining their local touch, the NHS Alliance has said.

A report on the ways PCTs have risen to the challenge of balancing the need to have the 'critical mass' to commission services effectively against the need to maintain local engagement includes a range of solutions from joint management arrangements through to associations of PCTs within larger health economies.

The report, Options in PCT Reconfiguration, looks in detail at some arrangements such as joint commissioning and lead commissioning, examining how they contribute to PCTs achieving their key functions.

Professor Edward Peck, director of Birmingham University's Health Services Management Centre and author of the report, said: 'The review looked at the principle of 'subsidiarity', in which activities are undertaken locally unless there are compelling reasons to collectivise them.' For example, lead commissioning enabled PCTs to overcome capacity issues by pooling expertise. Meanwhile, PCT 'associations' allow collaboration on large programmes, such as the national programme for IT. Both arrangements have allowed PCTs to maintain local boards, local clinical engagement and local public health work.

The report comes out against merger as a way forward. There is little evidence for the positive effects claimed for larger primary care organisations, it says, with studies showing no benefits in terms of performance or cost reductions.

NHS Alliance chief executive Mike Sobanja said: 'We have tried to look at what works. We do not want to see reorganisation thrust on PCTs from the top down.' The work was commissioned by the NHS Alliance prior to publication of A Patient-led NHS last month, which envisages PCTs working in partnership to make commissioning more effective.

NHS chief executive Sir Nigel Crisp told HSJ at the time of publication that he expected the number of PCTs to fall. It is well recognised that the DoH views the current 303 PCTs as unsustainable.

Options in PCT Reconfiguration is available from the NHS Alliance. E-mail office@nhsalliance. org