PCTs struggling in pivot tal roles

Primary care trusts are struggling to mature and get to grips with the most distinctive parts of their role, according to three reports from the Commission for Health Improvement and the Audit Commission.

In the reports, which come to remarkably similar conclusions, the two scrutiny bodies say that many PCTs lack management capacity and basic information, particularly about GPs and other professionals who contract with the NHS.

As a result, they say that many PCTs are struggling to develop commissioning and lead improvements in local services and the health of their populations.

CHI acting chief executive Jocelyn Cornwell recognised that 'these are not easy tasks and it is still early days'. But she said: 'There are bigger challenges on the way and it is therefore vital that PCTs strengthen themselves for the future.'

In its 'sector report' on what it has learned from 48 PCT clinical governance reviews, CHI highlights some positives. It says PCTs have established themselves, their own staff like working for them and 'a few' have impressed with their approach to commissioning.

However the report, What CHI Has Found in Primary Care Trusts, also says that while PCTs have responded to national imperatives on access, waiting times and national service frameworks, they have made little headway on local needs and services.

CHI says 'PCT commissioning is under-developed', and PCTs 'are not planning effectively because they are not yet using information fully.'

It also says lack of clinician involvement and public and patient consultation leads to 'a commissioning process that is divorced from the needs of patients and users and from evidence-based practice'.

Similarly, an Audit Commission report on the role of PCTs in reshaping general practice, Transforming Primary Care, due to be published this week, says 'capacity was stretched' and many lack critical information about GP income and workload.

A second report from the Audit Commission, on redesigning care pathways, Quicker Treatment Closer to Home, also due to be published this week, says 'services are often introduced without a thorough analysis of the level and types of activity needed to improve access, the human resources needed to deliver it or the costs that this should entail'.

All three reports also show that almost all PCTs are failing to monitor services for cost-effectiveness or quality.

NHS Confederation policy manager Janice Miles described the reports as a 'useful snapshot' of the situation some months ago, but 'not the most recent picture'.

She said PCTs were making progress in addressing capacity problems, even if the progress was slow, and the shift towards fewer national targets should help PCTs to focus on local issues.

'I think everybody recognises that the focus has been on secondary care and the national priorities around access and trolley waits, ' she said. 'But some of the new messages, on public health for example, are much more local.'

National Association of Primary Care chair Dr Peter Smith said he was not surprised at the findings:

'People have been chasing targets, there has been very little secondary commissioning and primary care commissioning has been thin on the ground.'

NHS Alliance chair Dr Michael Dixon accepted some of the criticisms, but he argued that it was to PCTs' credit that primary care had not 'gone belly up' during a period of focus on secondary care, particularly with targets.