Published: 18/11/2004, Volume II4, No. 5932 Page 25
Primary care trusts as we know them are doomed. Many proved too small to be effective commissioners, while their sheer number stretches staff resources and increases overheads. Even if the arrival of practice-based commissioning was not about to put the role of PCTs under an even brighter spotlight, rationalisation would on the cards.
Sooner or later PCT numbers will reduce to between 100 and 200. The inevitability of this is realised by ministers, and strategic health authority bosses are already mentally dividing their patches by two or three.
Some PCTs have already developed joint-working arrangements. They are required to have separate boards and professional executive committees, but they are increasingly meeting in joint session, and PCTs are expecting all restrictions to go after the election.
So why the reluctance to declare another bout of re-organisation? In part it is because all concerned feel that reorganisation is no answer to the service's problems when compared to clinical engagement, service redesign, increased investment and a host of other more worthy solutions.
And they are right - except that it is now blindingly obvious that the current PCT structure is getting in the way of delivering the best services.
An open and frank debate on PCTs that goes beyond political sound bites about the need to 'reduce bureaucracy' would be liberating and - in the run-up to an election - about as likely as Boris Johnson moving to Liverpool.
Off message welcomes contributions at hsjoffmessage@emap. co. uk
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