COMMENT : Cause for disquiet as lifespan of new organisations gets ever shorter

For the last quarter-century the NHS, under the influence of various reform programmes, has restlessly built and dispersed wave after wave of new organisations. The current reforms, driven first by the impetus of The New NHS white paper, and latterly by the NHS plan, are no exception. This 1 April will see the advent in the English health service of 122 new primary care trusts and the merger of eight health authorities (not to mention the transfer of hundreds of GPs from independent contractor to salaried status).

Two trends are apparent. First, the lifespan of the new organisations is diminishing exponentially: for example, contrast the longevity of 26-year old community health councils (now themselves under a long-delayed death sentence) with that of primary care groups - launched a mere two years ago and scheduled to disappear by 2004.

Second, unlike other areas of healthcare, restructuring is conspicuously exempt from any evidence-based considerations. Next month's changes will produce much bigger organisations than exist now. Yet, as the National Primary Care Research and Development Centre points out, there is precious little to suggest that merging PCGs into larger PCTs will produce cost savings or improved performance - let alone better accountability. The same goes for HAs. Which all but ensures that this reorganisation carries within it the seeds of the next.