NHS London is taking a tighter hold of its many primary care trusts by employing the capital’s lead commissioners as directors of the strategic health authority.
Five of the existing six acute commissioning sector chairs – who have so far split their time with running their PCT – will be made into full time directors for their patch.
We would like to give sector chief executives more authority over their patches, without going for PCT mergers and a big reorganisation
The north west London sector will be led by NHS London deputy chief Anne Rainsberry, with Westminster PCT chief executive Michael Scott returning to the PCT full time.
The new chiefs will be responsible for all performance management in their patch.
The changes come against the background of plans for huge and controversial service change in London - a response to poor outcomes, growing demand and investment cuts.
The SHA says hospital activity needs to be reduced dramatically and plans are being developed – some leaked to the media – for major reconfiguration. These have prompted resistance from politicians, campaigners and some acute trusts. Proposals include mergers of several acute trusts.
Meanwhile, the 31 London PCTs have been told to quickly develop services based in the community, often in the form of new health centres which are opposed by existing GPs.
NHS London chief executive Ruth Carnall said: “We think we have made quite a lot of progress but would like to give sector chief executives more authority over their patches, without going for PCT mergers and a big reorganisation.”
She said moving further functions to sectors would contribute to the 30 per cent cut in management costs required by government, and help the SHA shape its work around supporting the sectors.
The change will mean there is still flexibility to shape commissioning depending on proposals after the general election, Ms Carnall said, and it would allow PCTs to further explore joint commissioning with borough councils. The SHA is planning to set out models for how it can work.
Ms Carnall said: “At the moment there are a lot of different models and it is not clear what we are trying to do.”
She acknowledged some London PCTs were currently “less than enthusiastic” about joint working with boroughs.
Mr Scott said the change to full time sector chiefs was a “good opportunity for me to focus on Westminster”, in particular the development of polysystems – the alliances of GP practices which will host the out-of-hospital services.
He said: “I support the move to full time roles because the sectors, and aggregated commissioning, has an important role to play.”
The sector chief executives were appointed in March last year and described at the time as an “inner cabinet” for the NHS in London.
They will remain employees of their PCTs as well as NHS London, but their PCT roles will be covered by deputies.