spotlight In the first of four articles looking at life on the frontline of the primary care-led NHS, Chris Gallagher reports from Leeds where a new primary care trust is treating daunting challenges as 'business as normal'

Published: 11/4/2002, Volume II2, No. 5800 Page 14 15

Anyone standing in the village churchyard of Shadwell in the old West Riding, Yorkshire, will find it hard to imagine that they are 10 miles inside the borders of the new North East Leeds primary care trust.

Arable fields and stone-built cottages conspire to create the illusion of a bucolic idyll, the only hint of urban reality coming from a row of 1970s housing estate rooftops just visible between the last of the graves and the first fields.

The PCT, one of five created in Leeds this spring, all of which became operational on 1 April, comprises three localities:

Chapeltown, a run-down, deprived inner-city area notorious as a centre for drug-dealing, related crime and health problems, but a young, ethnically diverse neighbourhood where strenuous efforts are being made to rejuvenate the area; Moortown and Roundhay, essentially middleclass, middle-aged suburbs extending to the rural fringes of the city; and Wetherby, the wealthier, more elderly, rural environment to the north east of the city.

Neither the executive lead nurse for the new trust, Gabrielle Atmarow, nor its chief executive, Thea Stein, admits to being in any sense awed by the mix, but both agree that the trust has a diverse set of challenges facing it and that there have been some problems in the lengthy run-up to becoming operational.

Ms Atmarow says: 'It has not all been easy, but in three years We have advanced from being an organisation with a general manager, an executive nurse and a secretary to one which is ready to provide and commission services.

'In that sense the transformation has been fairly rapid.We have been trying to bring together 28 general practices, all individual organisations that have retained their independent status, and build around them an organisation and infrastructure that has the sense of direction and values that reflects local needs.'

It has not, she concedes, been plain sailing; some GPs were keen, others less so and other staff groups also had to be won round.

She is convinced, though, that those closest to the change are already feeling differently and that others will do so in due course.

'For district nurses and health visitors, whose workload is the same this week as it was last, the difference may not be immediately apparent.

But the fact is they now work for a different organisation, one that has a renewed sense of direction and a greater depth of responsibility. It may be only over time that they start to feel different.'

Thea Stein says that whatever teething problems there may have been for the trust, they pale into insignificance compared to those faced by their colleagues in Leeds East: 'All their systems went down yesterday and they had to abandon their building while rewiring work was done. We had minor headaches like getting headed stationery - issues that were solved - but really they are issues that crop up every single day when you are going through huge organisational change and There is a huge developmental agenda.

'There are big challenges for the health service in Leeds, but those challenges are the same today as they were a year, two years or three years ago.'

She concedes, however, that a lingering problem exists in community nursing, where, although there are no unfilled vacancies, district nursing levels are below those of their neighbouring PCTs: 'It is a problem across the city, but one that is worse here and we are looking for the money to solve it.

'We are not solely dependent on government coffers and we'll look creatively at everything we do. But two years ago this same problem existed and it wasn't solved. We are now better placed to do something about it because we are closer to it.'

For all her robust confidence in PCTs, Ms Stein considers further structural change is inevitable if the changing needs of the population are to be met.

'I expect primary and community services will be better because of PCTs. They will be of a higher quality, more consistent and more integrated.

'I cannot guarantee that PCTs will be here in five years' time, but that should not matter; the structure doesn't matter. The PCT initiative is a good experiment and it is the only one worth being around at the moment - but change is inevitable.'

Gabrielle Atmarow adds: 'While we are here, I expect we will improve the health of local people, improve access to services and hopefully reduce health inequalities. That is our raison d'être.'

It may be a tall order in the social, economic and geographic diversity that is the North East Leeds PCT.