PCTs to lose responsibility for GPs

The government has already announced plans to make GPs the lead commissioners for care worth up to £60bn. HSJ understands this will mean 500-600 GP consortia contracting directly with a new independent NHS board, removing all of PCTs’ existing GP contracting and performance management functions.

PCTs are screwed. If you’ve got shares in PCTs, I think you should sell

A senior Department of Health source told HSJ: “PCTs are screwed. If you’ve got shares in PCTs, I think you should sell. They are under more threat than the strategic health authorities.”

The coalition government’s document Our Programme for Government said PCTs would have a responsibility for public health spending, act as a “champion for patients” and commission “residual services”.

Public health spending accounts for approximately £4bn a year - just 4.7 per cent of the total £84bn now allocated directly to PCTs. HSJ has been told the further “residual” commissioning responsibilities likely to be left with PCTs include maternity care, optometry, pharmacy, dental services and services for patients “GPs don’t want” such as homeless people.

DH and PCT sources said the government’s plans meant the future for many staff employed by PCTs now lay in “selling [their] services to GP consortia”. The DH source said: “If I were them I would be trying to do a good job now. Some of them would be a shoo-in as managers of a consortia.”

The radical nature of Mr Lansley’s plans for GP commissioning have not been lost on the NHS Confederation - whose acting chief executive Nigel Edwards met with Mr Lansley at the end of May.

In a letter sent to confederation members about the meeting last week and seen by HSJ, Mr Edwards said most commentators had “underestimated” how radical the changes would be.

“In the NHS we are used to reform and reorganisation which changes the architecture: the organisations get bigger or smaller and titles change but mostly existing power relationships remain intact,” he said.

“The proposed programme goes beyond this to fundamentally change the healthcare system.

“The intention seems to be to put all the enabling mechanisms and the policy framework in one set of reforms and allow the detail of how they work on the ground to be developed locally, as opposed to the approach of the last 10 years of a more step-wise approach.”

But the lack of detail on how GP commissioners will be managed and scrutinised is raising concerns, including at the Treasury, where officials are worried Mr Lansley’s plan to transfer the vast majority of NHS spending to untested organisations comes just when the NHS needs to make significant efficiency savings.

One PCT chief executive said: “The inconsistencies of this policy are so gross they cannot be avoided. We need somebody to articulate in greater detail how they want the system to look.”

A chief concern is where the line of accountability will sit and who will be the accounting officer for GP commissioners. At present that accountability lies with PCTs, but DH officials are considering transferring it to either consortia chiefs or independent board regional offices.

News of the uncertain future of PCTs comes as SHA regions have been given separate management cost reduction targets. The 2010-11 operating framework said the target was 30 per cent by 2013-14. But HSJ has been told the target in the South East Coast region is 40 and in London it is 50.

A DH spokeswoman confirmed differential targets had been set and warned: “We are reviewing the need to go further and faster in light of the commitment to reduce costs in bureaucracy and admin.”

Doubts have also been raised over PCTs’ future public health role, which many expect to pass to local authorities once the technicalities of bringing elected members to PCT boards are discussed in Parliament.

Asked by HSJ whether this was a likely outcome, the health secretary said: “We will be saying more about this in the white paper. We are not going to try to drive the service by changing structure. Function will change and form will follow function.”