As an organisational concept, the 'supra-PCG' makes a lot of sense. But care must be taken to ensure that the development of such models is managed from the 'bottom-up' as well as the 'top-down' perspective.

Organisational structures should be underpinned with clear lines of financial accountability, based on coherent frameworks of budgetary delegation. This can only be achieved on the back of a comprehensive analysis of all areas of potential spend, both pay and non-pay: a prerequisite in the planning process.

In identifying spend areas, the less glamorous (but essential) aspects of non-pay activity should not be overlooked. Most important in this respect would be the requirement to develop a strategy embracing all aspects of goods and service procurement, linked to the firm duty to achieve ongoing economies of scale and value for money.

A further area is the management of premises. Again, major efficiencies could be gained from a 'supra-PCG'-wide approach to looking after premises, with contracts for services such as estate maintenance let and managed on a multi-site basis.

In both these examples, the need for informed advice at the organisational planning stage is vital. There is a wealth of purchasing and facilities management expertise available in the NHS - particularly at trust level - which is itching to be utilised.

Simon Appleton

Facilities manager

Hounslow and Spelthorne Community and Mental Health trust