Published: 04/07/2002, Volume II2, No. 5812 Page 8

Primary care trusts could be compelled to adopt the spending recommendations of regional specialised commissioning groups, according to a leading commissioner.

Head of specialised commissioning for the London group Barbara Gill claimed at a symposium at the British Renal Society that the current ministerial review into the issue could mean PCTs accepting spending plans or investment proposals put together by the groups. Currently, PCTs are responsible for commissioning specialised services - including renal services - only in 'collaboration' with commissioning groups.

Ms Gill said: 'PCTs can opt out of the decisions. We might go through quite a long planning process to decide what needs to happen, develop business plans, and when it all gets added up they can say, 'I cannot afford that'.

There is no formal mechanism to insist that PCTs honour the agreement.'

She predicted the current review - which was 'very low profile' - was likely to result in six or seven issues for consultation to be published in the Department of Health's chief executives bulletin 'very soon'.

'Specialised commissioning is not a high priority in the DoH at the moment.

'There is weak national leadership - this is not a comment about any individual, but there is no senior champion for specialised commissioning in the department. It is very much being lead at a junior level and doesn't have the profile of other services.'

The suggestion of binding agreements have angered the NHS Alliance, which said the move would 'go against the entire ethos of a primary care-led NHS outlined in the NHS plan'.

And, it claimed, with restricted PCT budgets and the costs of specialised services, it could also mean cash being diverted from national service framework commitments.

'PCTs have been put at the forefront of the NHS and they have been given the responsibility to deliver, but you also need authority, ' said an alliance spokesperson.

The alliance claimed that the groups' recommendations could absorb 20 per cent of an average PCT's budget.

'There is not enough money in the system to fund everything. But through this idea, you may end up sacrificing investment in, say, the coronary heart disease framework to fund specialised commissioning. Is that acceptable?'