Select Committee on Health Written Evidence


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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