Memorandum submitted by Philip Barrett
(PCT 5)
I am writing in respect of the enquiry next
week regarding changes to Primary Care Trusts. The opinions I
express below are personal, and as a consequence I will not disclose
the identity of the Primary Care Trust for which I work.
I joined the NHS in 2002 from a senior position
in private industry, having been enthused by the principles behind
Shifting the Balance of Power. The concept of a local body providing
the best health services for its own population was particularly
appealing. The benefits of local accountability and focus were
clear.
In the ensuing three years, my PCT has made
significant progress in achieving these aims. Local initiatives
have been developed of major benefit for our local population,
which arguably would not have occurred had the organisation been
subsumed in a larger body with conflicting priorities. We have
achieved excellent clinical engagement, and we are consequently
making good progress on the development of practice based commissioning.
We are now facing assimilation into a county
wide PCT, with a population in excess of one million compared
with the 100,000 for which we are currently responsible.
The arguments for this change leave me unconvinced.
We are accused of failing as commissioners, without any evidence
being provided. In our local health community a well developed
system of lead commissioning has been in place, leading to a critical
mass for negotiating with our providers, most of whom are Foundation
Trusts.
The real driver for merger is said to be financial,
with the target of £250 million to be saved. In reality such
reorganisations rarely actually save significant sums, given the
requirement to establish locality structures below the county
wide PCT in order to attempt to preserve local clinical engagement
and local focus.
The existing mature systems of relationships,
governance arrangements and risk management structures will need
to be re-invented in the new organisation, and it will take at
least 18 months and a huge effort to restore the effectiveness
of systems back to the level we are currently achieving.
The distraction this exercise will generate,
together with the demoralising impact on staff, will certainly
make it more difficult to address the financial positions of the
PCTs over the next 12 months. Trust Boards with a limited life
expectancy may not be over interested in making the necessary
service reconfigurations for long term benefits but with short
term pain.
The whole process of Commissioning a Patient
Led NHS to date has been badly handled, with conflicting guidance
particularly about timing and the future of Provider Services.
This does not help senior managers implement the reconfiguration,
with ground rules changing with no notice and all giving a clear
impression that the policy is being developed on the hoof.
It is disingenuous to argue at the centre that
the impetus and direction of change has come from the grass roots.
We have been left in no doubt that a minimum number of PCTs had
to be achieved on financial grounds.
To summarise therefore:
— Primary Care Trusts were established
to serve the particular needs of a local population. How will
this be preserved with one body serving a shire population?
— Local Primary Care Trusts facilitate
clinical engagement. How will this be preserved with one body
serving a shire population? How will Practice Based Commissioning
be facilitated by having one county wide PCT?
— Primary Care Trusts can commission
effectively through lead commissioning arrangements.
— The new organisation will not save
money in the short to medium term.
— The progress made in the last three
or four years will be lost.
— The distraction from reorganisation
will damage financial performance.
— The process seen to date has been
poorly thought through and guaranteed to bewilder and demoralise
staff.
— The NHS does not need such a reorganisation.
I am not convinced it is broken, so why try to fix it?
Philip Barrett
28 October 2005
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