Monday, 07 November 2005
All quiet in London PCT-land, or not
PCT chairs in London were told last week that the Department of Health had decided that the status quo must continue in terms of borough-based Primary Care Trusts (though that leaves City and Hackney and Merton and Sutton PCTs somewhat out on a limb). Therefore there will be no need for the anticipated consultation on PCT reconfiguration. The real reason for this was not that a case could not be made for bigger, stronger, more efficient multi-borough PCTs. It was, on the contrary, that any change from current co-terminosity risked provoking overwhelming political opposition from local authorities and London MPs - many of whom scarcely acknowledge each others existence, much less cooperate, at other times. It may look like a victory, but Boards should be wary of dancing in the streets too soon, if at all.
M-A-C’s view is that the issue of 'what future for PCTs/the commissioning function' has been ducked rather than resolved. This announcement should not be seen as a victory for borough-based PCTs, so much as a deferral (read 'fudge') of the hard question until after the London local elections in May 2006. London will still have to find its share of the £250M recurring savings from reconfiguration, some £42M, of which about £10M is supposed to be found from the reconfiguration of 5 SHAs into a Pan-London Strategic Health Authority.
It is claimed by the champions of borough-based PCTs that this sum can be found from the present structure. If that is true, why has it not been found previously given the parlous state of finances of many London PCTs? Even with co-terminosity retained, PCT Board and PEC changes are still likely - smaller and more business focused. PECs may go as practice based commissioning progresses. We don't need both. PCTs are still undergoing internal restructuring to separate provider functions and move to a care group approach ' which has major implications for public and user involvement. Things will not be stable in London's PCT-land despite this announcement.
M-A-C laid out its case for multi-borough commissioning bodies (call them PCTs if you want to) back in September. We think that affords considerable opportunities for increasing real user influence where it matters and we stick to that view. There is nothing sacrosanct about having borough-based PCTs and boards. What matters to the health of Londoners is getting the health improvement and commissioning work done with a borough and neighbourhood focus. There are ways to do that without having 30+ NHS bodies duplicating effort around London and diluting the potential clout of commissioning.
Keeping things as they are simply puts off the day, though not for much longer, before Foundation Trusts start to make their move into primary care. Once that starts to happen, stand by for a real shift in how things get done.