Primary care trusts have overseen improvement and were further “maturing” before their abolition was announced, an NHS Confederation report says.
The report, The Legacy of Primary Care Trusts, says: “With no direct comparators historically, in other parts of the UK or internationally, it is impossible to compare the performance of PCTs with that of other organisations with an equivalent set of responsibilities or facing equivalent conditions.
“We will also now never know whether PCTs would have continued to improve their capability, influence and outcomes had they been given the opportunity to develop as commissioner-only organisations focused on long-term local health improvement objectives.
“However, the evidence set out in this paper suggests that they were heading in the right direction in terms of both their internal skills and competence and their impact on the health of local communities.”
The report points to improvements since PCTs’ establishment in 2002 in health, for example cancer survival rates, in the quality of services, such as reduced waiting times, and increasing ability to balance the books and deliver value for money.
PCTs’ assurance scores under the world class commissioning framework indicated they were improving. And the report says: “There was good evidence PCTs were becoming more sophisticated and effective in their approach to commissioning before the announcement of their abolition [in July 2010].”
The report accepts PCTs’ success varied and says “one of the biggest factors [was] the quality of the leadership, not just in the PCT but of local partners”.
It identifies several major external barriers to PCTs meeting their aims – including the regular addition of new duties and strictly managed targets, and frequent structure reorganisations.
In addition it says DH policy “too often favoured the interests of retaining stable providers” and PCTs’ “status” was less than providers – limiting their ability to commission.
The report says: “It is unreasonable to blame PCTs for the constraints of the system within which they work. But despite these constraints, PCTs have delivered significant improvement in the NHS in the areas they have been asked to focus on.”
“We believe the evidence of progress made by PCTs should be acknowledged… New commissioning bodies will face many of the same challenges and pressures as PCTs. If they are to be given the greatest chance of success, it is essential we take a realistic and balanced view of PCTs’ work so we can learn the lessons for the future of NHS commissioning.”