Health and Social Care Bill

Memorandum submitted by Tony Plumridge (HS 107)

1 As Chairman of a Primary Care Trust (PCT) for seven years my experience was that the management of the NHS would not be improved by Commissioning Consortia of GPs. In my own PCT the GPs were very reluctant to attend meetings and initially very reluctant to discuss commissioning in public. Their training and skills are concentrated individual relationships at which they are exceptionally good. These relationships are highly confidential. GPs are not trained or experienced in open debate on larger issues in public and most of them do not wish to undertake this role.

2 Contrary to public perception the PCTs were significantly under managed. Approximately 5% of our budget was spent on management compared to 10% in almost all other large organisations. This misperception in part arises from the reclassification of senior frontline staff as ‘managers’ when in reality they had no management qualifications.

3 Existing PCTs could be simply modified to require a majority of clinicians on the key committees and the Board thus giving the power to commission to GPs but retaining the existing management structure and support . This would avoid the chaos of a large reorganisation and the inevitable decline in productivity.

4 In my experience many of the problems of the NHS have arisen from constant change and the subsequent lack of accountability. The use of private services such as Nursing agencies has exaggerated these problems. It is very difficult to provide consistent care without building long term teams.

5 GPs are excellent at their own work please do not distract them from this by imposing management duties upon them.

6 In my PCT the public were heavily involved and many attended our public meetings . So far the pilot commissioning bodies have significantly failed to involve the public in any meaningful way despite the huge changes proposed.

7 There is no political mandate for this these changes which are the largest administrative changes being attempted anywhere in the world.

8 South Cambridgeshire PCT claims that it is already achieving the Secretary of States aims under the present system of management , if this is so why spend £1.4 billion and the subsequent loss of productivity in a fruitless change.

9 I am personally deeply concerned by the Secretary of State’ s apparent reluctance to engage in meaningful debate with the public on this issue.

10 The system of PCTs engaged many leaders from industry, local government, education, and management professions who were able to contribute their expertise at minimal cost to the NHS – this will be lost . The NHS is about joined up thinking and these proposals would unravel what was becoming an effective system in which the public and private sectors worked with the NHS to provide better health outcomes.

11 There was a tiny minority of doctors who tried to exploit the PCT system for their own benefit and not for the benefit of patients. I fear that this minority will seize the opportunity to exploit the NHS which these changes appear to offer.

March 2011