primary care trusts

Published: 30/01/2003, Volume II3, No. 5840 Page 28 29

Primary care trusts'chronic shortage of human resources expertise is hampering their development.Liz Newbronner and colleagues report

Primary care trusts are relatively new organisations and many lack access to human resources expertise. Our research, looking at the organisational and management challenges facing PCTs, also indicates that HR managers are being asked to work above their level of experience, often in situations where they are professionally isolated.

We have been working with six PCTs in the following strategic health authorities: Avon, Gloucestershire and Wiltshire; County Durham and Tees Valley; London; Thames Valley; Trent; and West Yorkshire.Most are in urban areas, all six are 'third-wave' PCTs and all were part of the original group of 72 primary care groups/PCTs involved in the national tracker survey. Three of the PCTs are the result of PCG mergers.

The first round of fieldwork with the PCTs, which took place in autumn/winter 2001, focused on clarifying the key organisational development and HR challenges they were facing. At that time the PCTs were not only very new organisations, they were also just beginning to absorb the implications of Shifting the Balance of Power. The availability of HR support was a key concern for all six.

Three PCTs were receiving their HR advice and support from their local acute trust, one from a community trust and two were using a shared services agency which served a number of PCTs, trusts and HAs.None were wholly satisfied with their current level of HR support, but those that had a service level agreement with an acute trust were most unhappy. Five main concerns were highlighted:

Chief executives and directors felt very exposed on strategic HR issues. They wanted high-level HR input but often found that this simply was not available from their service provider or not when they needed it. One PCT chief executive said: 'We really suffer because we really do not have any dedicated HR advice.'

All PCTs were concerned that middle-level HR managers were effectively being asked to operate at a senior or strategic level without the experience or support required to do this effectively. Another chief executive described the PCT's HR manager as being 'between a rock and a hard place'. They said: 'She doesn't normally work at a strategic level, but we are asking her to do that and it puts her in a difficult position. For example, I've been asking her to think about the PCT's approach to Improving Working Lives, but within the acute trust's HR department an assistant director has responsibility for that, so their response is 'what are you worrying about that for? It is not your problem'. But within the PCT, it is her problem because there is no-one else.'

Poor understanding of HR issues Several of the PCTs, and particularly those that had service level agreements with an acute trust, were frustrated with the lack of understanding of the challenges facing PCTs. They felt that PCTs faced different HR issues from those in acute trusts, such as integrating new staff into the organisation and establishing common terms and conditions across the workforce. PCTs also felt that common issues like Improving Working Lives required a different approach in PCTs, where the workforce was much more dispersed, than in an acute trust.

HR management capacity

All the PCTs felt the resources available to purchase their HR support and advice were insufficient and that this led to unsatisfactory arrangements.

One chief executive said: 'We were advised not to have our own HR department for economic reasons, but what That is meant is that We have had to set up a new organisation with almost non-existent HR support.'

PCTs that had a service level agreement with a shared services agency were more satisfied with their arrangements, but even they had concerns about HR management capacity, particularly in areas such as workforce information and planning. Some PCTs did not have basic information about the number, location and grades of the staff employed.

Need for an 'expert customer'

Between the PCTs, there was wide variation in who led on HR. In one it was the director of corporate development, but in others it had been determined by whoever had the time.One director noted:

'I think that me having the lead for HR is really inappropriate... But there is no-one else that would necessarily be any better at the moment.'

A finance director who was also unhappy holding responsibility for HR suggested that PCTs need someone who can act as an 'expert customer' in house, with sufficient knowledge of HR management and policy agendas to manage the service level agreement.

This approach was also of interest to HR managers within shared services agencies, who sometimes felt frustrated dealing with PCTs that lacked knowledge of HR issues and therefore did not know what they wanted from their service level agreement. One HR director in a shared services agency said: 'The problem is that they do not really understand what we are supposed to be doing... When all your customers are inexperienced and the corporate memory has gone because of mergers and reorganisations, how do you begin to get [PCTs] to recognise the issues?'

HR management at GP practice level All six PCTs had concerns about the mixed quality of HR management at GP practice level. But most had felt unable to address this issue systematically.This was partly a problem of time and competing priorities, but also a desire to 'influence and facilitate' rather than 'require'GPs to change their HR management practices. Several also noted that until the PCT had tackled some of its own HR issues, it was difficult to preach to GPs about their HR management.

Evidence from the second round of fieldwork with these PCTs last year suggested that progress was being made.One PCT had appointed its own HR manager.Another had revised its service level agreement with the local acute trust to include a dedicated HR manager.A third was working with neighbouring PCTs to establish a shared services agency for HR and withdraw from its service level agreement with the acute trust. But concerns about lack of access to HR expertise remained.

It is clear from this research that the Department of Health's intention to improve the status and capacity of HR management in primary care is long overdue and much needed.Whether they have an in-house service or buy in to a shared service, PCTs need effective HR support and advice if they are to address successfully the tough local and national agendas they are facing. l Joint working: shared responsibility A primary care trust worked closely with its local social services department to establish joint planning/commissioning posts to lead the development of services for key client groups.There were some difficulties to resolve, including who would employ the new post holders, what their terms and conditions should be and the implications for existing staff from both organisations.

A director said: 'We met our human resources person from the acute trust and the HR person from social services and it was obvious that the HR person from social services engaged with the issues and felt part of the organisation.

They had thought about the implications from social services'point of view in a way that our HR lead just hadn't because she didn't understand the complexity of the issues.She doesn't perceive herself as really being part of the PCT.'

Good practice: investing in people

One primary care trust was particularly keen to encourage all its GP practices to be good employers.They looked at several initiatives:

Training for GP and practice managers in key skills - for example, recruitment and retention and staff appraisal and development.

Identifying a handful of practices to champion Investors in People.

Raising awareness of key policies such as Improving Working Lives.

Standardising the terms and conditions of practice staff across the PCT.

The human resources lead director said: 'We need to establish good employment practice, not only for the people we employ but also for our general practices... I've started discussions around Improving Working Lives and Investors in People, but without the technical expertise sitting with me to help and support its development.'

Overwhelming possibilities: a problem shared is a problem doubled One primary care trust, which received human resources expertise from a shared services agency serving five PCTs, reported that the shared services agency itself had difficulties recruiting HR staff, including at director level, and this affected the PCT.

The chief executive said: 'The creation of the PCT, the protection of employment regulations, setting up new payrolls and so on, all required a high level of HR input.The HR team has just been overwhelmed.

'So We have had to do a lot of work locally within the PCT, literally going into offices and finding out who's there.'

The HR director from the shared services agency acknowledged these difficulties but felt the shared services approach was still the best way to use scarce HR resources.He said: 'We have HR managers coming back into the NHS or leaving large acute units to join us because now we have a structure to offer. I can't see recruitment and retention of HR professionals working as well in a decentralised model.'

Key points

Research with six primary care trusts, started in 2001, suggests that many lack access to relevant expertise in human resources management.

Where PCTs do have human resources directors, they are often being asked to act on strategic issues which are outside their experience.

PCTs required to rely on acute trusts' HR departments for HR expertise find this unsatisfactory as the issues facing the two sectors are so different.

The status of HR management in PCTs needs to be boosted.

Liz Newbronner is visiting fellow, York University health sciences department, and director, Acton. Shapiro consultants. Dr Mike Pedler is visiting professor, York University leadership development centre.

Dr Tim Scott is a Harkness fellow and visiting scholar, California University public health school.