Do you ever wonder what it feels like to be in the frame for everything that is wrong about the NHS? That’s pretty much what it feels like if you are a commissioner in a PCT - with perceptions that bureaucracy, inefficiency and waste of resources are to be resolved by the emerging GP consortia.
The latest broadside comes from Barbara Hakin - managing director of commissioning and development - who is quoted in HSJ warning that consortia shouldn’t be using PCTs for commissioning support. She says that if GPs turn to PCTs, commissioning wouldn’t be the “professional and highly attuned system that it needs to be.”
Some PCTs are looking at the option of developing into commissioning support enterprises, and indeed, BMA GP committee chair, Laurence Buckman has told GPs to look to NHS managers for support and advice rather than the private sector.
Dame Barbara talks about “really great NHS staff” but points out that that consortia will also have the choice of independent and private sector staff. She urges people to think outside the box. Yes! Given my last blog, I can see the sense in that - but at the same time, I do think it is time that the quality, commitment, loyalty and talent of staff working in PCTs was put in the spotlight.
If we are to retain that talent for the future, we need to give GPs a chance to see what good work is being done, how challenging and complex the commissioning agenda is, and explore what will work best at local level.
Sweeping generalisations about PCTs - for example, being reticent to share across boundaries- doesn’t wash. As with many things, there are examples of excellent practice, areas where things are less advanced, and inevitably, poor performers.
Demoralising as it may be to know that our organisation will cease to exist by 2013, we can still celebrate the things that we are doing well, and make sure that we support our staff through the transitional times ahead. And we have a duty to make sure that we hand over systems and processes to the consortia in good shape.
I’d like to think that the GPs have the intelligence and common sense at local level to make decisions based on what is best for their communities, using the best of what the PCT has to offer, and building on the work that has been done to achieve the best outcomes for patients - having made sure they understand what the strengths of the PCT are.
Whilst we were told that it would be an end to “top down” directives - and GP consortia would be structured at local level, it seems to me that the “top” can’t resist endless steering.