Published: 21/02/2002, Volume II2, No. 5792 Page 25
Dr Michael Dixon's fears for primary care trusts illustrate the naivety characterising the GP entrepreneurs we look to for leadership.
The reforms are not going wrong; they are going perfectly to plan. The centralised control of every aspect of NHS life is virtually complete. The National Institute for Clinical Excellence will tell us what drugs to prescribe; the Commission for Health Improvement will see we do it. We have national agencies policing doctors' standards, patient safety, drug users' treatment, care home standards and now infection control and health protection.
We have national service frameworks and an NHS plan.
We have large strategic health authorities bearing no relationship to any other organs of government or service organisation, and therefore existing solely as the eyes and ears of central government for the NHS.
The NHS plan and the subsequent reforms are an acute trust's charter. Locally we are already cutting back on public health and primary care priorities and programmes in order to meet the national targets and the insatiable capacity of hospital care to consume resources.
Dr Dixon is right to be fearful for the spirit, adventure and innovation which PCTs are capable of generating. But the NHS is going exactly to plan.
John Middleton Director of public health Sandwell health authority
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