PCTs to go in massive NHS reorganisation

Tags: Conservatives Credit crunch information strategy Lansley Liberal Democrats Liberating the NHS Nicholson

12 Jul 2010

Health secretary Andrew Lansley has announced that primary care trusts are to be abolished as part of a massive reorganisation of the NHS that will start with the Department of Health taking more control of its finances to ensure a measure of stability.

At a press briefing to launch his white paper – 'Equity and excellence: liberating the NHS' – Lansley said the coalition government had initially expected PCTs to have a ‘residual role’ but it became clear they had no future as its plans were firmed up.

GPs will be given responsibility for commissioning most NHS services, working either for the patients of their own practices or for wider populations as part of commissioning consortia.

Responsibility for commissioning specialist and tertiary services will pass to a new NHS Commissioning Board; which has accrued more and more powers as the government’s plans have emerged.

The board will also be responsible for commissioning dentistry and primary medical services (or the services that GPs themselves provide), for setting the NHS tariff and a wide range of standards, and for intervening in ‘failing’ commissioning boards and provider trusts.

PCTs’ public health and health promotion responsibilities will pass to local authorities, who will also be given new roles in scrutinising the NHS and for commissioning new Health Watch services that will operate on a similar model to the Community Health Councils abolished by Labour.

The white paper says a new, national Health Watch will operate as “an independent consumer champion” from within the Care Quality Commission, which survives as a quality inspectorate.

Other quangos with an apparently assured future include Monitor, which is destined to become a market regulator; NICE, which will develop quality standards to replace targets for the NHS and social care; and the Information Centre, which is billed as having ‘lead responsibility’ for collecting data to give patients more choice over their treatment and care.

The DH will eventually be slimmed down to become a Department of Public Health, while strategic health authorities will be "phased out" and trusts will be expected to become both foundation trusts and social enterprises.

However, at the press briefing, NHS chief executive Sir David Nicholson, said it might be necessary for the DH and SHAs to take more control in the short term. “There is a very clear and coherent vision of the future of the NHS,” he said.

“The big issue is how we get from here to there. In the short term, we may need to take more control nationally and regionally of the money in order to decentralise later.”

Much of the detail of the white paper will be fleshed out in strategies and documents that will be issued over the coming months.

However, in response to a question on the future of the National Programme for IT in the NHS, Sir David said: “In the next four weeks we will be making an announcement on the NPfIT and how we will reconfigure and change it to reflect the bottom-up changes in this document [Liberating the NHS].”

The white paper says there will also be an information strategy setting out how the government will make good on the Conservatives’ manifesto promise to deliver an “information revolution” to patients.

“Our vision is patient centered-something we’ve called “no decision about me, without me,” Lansley told the House of Commons as he presented the white paper to MPs.

“With patients empowered to share in decisions about their care, with professionals free to tailor services around their patients, and with a relentless focus on continuously improving results I am confident that we can deliver the efficiency and the improvement in quality that is required to make the NHS a truly world class service.”

However, former health secretary and Labour party leadership contender Andy Burnham said the proposals were “a roll of the dice, a giant political experiment with no pilots and no evidence. It turns order into chaos.”

Link: Department of Health press release and links to the white paper, equity and excellence: Liberating the NHS.

Lyn Whitfield

Treasury frets about GP commissioning (25 Jun 2010)
Lansley: 'NHS not protected from change' (24 Jun 2010)
Unison attacks abolition of SHAs (25 May 2010) (19)
Data published as Whitehall is reviewed (03 Jun 2010)

Readers Comments

good riddence, as the saying goes

12 Jul 10 17:14

Be honest now, when was the last time you felt your SHA was being strategic, they lost that when the became target police.

As to PCT's, they grabbed Darzi and NPfIT / NLOP powers like drowning persons, except of course they tended to just pull everyone down with them.

The failure of NPfIT has been a massive loss to the NHS, attributable not least to CfH and SHAs CIOs. Such chances don't come very often, so who let the programme be run and overseen by such poorly performing people. Where was the DoH/CFH ability and leadership to set it straight at the start? Why did DoH confuse large salaries and belligerence, understanding with ability? Where was the DoH/SHA leadership to provide governance and keep the programme on track? Who will be held accountable for such a tragic waste of time, opportunity and resources.?

Who am I? Well just a hapless Acute IT Director, used to being bullied into ridiculous actions and programmes by my PCTs and SHA masters. Why can’t I say who I am? Well I would be blacklisted by those who remain in power. Maybe such an answer addresses the earlier points.

bonkers

12 Jul 10 20:14

Devolve power by bringing it back to the centre. Make healthcare more accountable by giving most of the power to private contractors ie GPs, and the American Healthcare Commissioning organisations that are circling the NHS. Make hospitals less accountable, and give more power to Monitor, who haven't got the best track record, as a quango organisation with very little accountability to anyone.

I see no value for the taxpayer in what is planned, only loss of control, and public money going to their profits.

I work for a PCT, they are not perfect, but where they save money by changing contracts, this goes back into healthcare provision, not personal income. And they are working for a whole population, balancing the needs between primary, secondary and tertiary care.

Getting the balance right is not easy, but the biggest problem is that repeatedly the government of the day meddles by massively re-organising, rather than gently tweaking. The illusion of progress, whilst creating demoralisation, confusion and chaos.

And they claim to want to save money. Quite ridiculous.

Come now...

12 Jul 10 22:31

Failure of NPfIT? Really, I think you should probably be more specific. Some elements of NPfIT have undoubtedly been failures by any reasonable benchmark, but the Programme as a whole? I think many would disagree with you there.

And PCTs have clearly kept themselves busy or there wouldn't be any responsibilities to be handed on to GPs and councils! I think a lot of people will miss them in a few years when GPs are bogged down in commissioning paperwork and workers in local councils are struggling to understand the complexities of managing public health campaigns.

Track Records

george.brown103@ntlworld.com

12 Jul 10 23:29

Any involvement of Local Councils worries me - now if they could just concentrate on trying to take the rubbish away just once a week first.....

not total failure

Neil.Bhatia@nhs.net

13 Jul 10 09:11

I agree, some aspects of the NPfIT have been successful and very useful to GPs particularly.

NHS mail has been extremely useful for many, not just secure emails but SMS and FAX within the application. I only wish more hospital trusts would use the nhs.net addresses so that we GPs could communicate - and refer - securely, easily and rapidly with our consultant colleagues.

GP2GP - especially EMIS-EMIS - works very well, albeit exposing the very wide variation in summary/data quality that still exists across England's GP practices.

Some have found Choose & Book useful, others not. We tried it and abandoned it.

Hope over experience

13 Jul 10 12:52

I find Mr Lansley's faith in the ability of massive reorganisation to solve the NHS's 'problems' once and for all rather touching. It's reminiscent of Haig on the western front: one more big push and we'll be sipping tea in Berlin. Yes, touching and...utterly moronic.

re: Hope and Experience - point well made but we can't take perseverance away from the man

13 Jul 10 15:28

Whatever individual views are regarding the changes announced this week, what can't be overlooked is that Andrew Lansley has shadowed the health secretary post for over 6 1/2 years since mid 2004 during which time Labour has had a succession of names on the main door John Reid, Patricia Hewitt, Alan Johnson and Andy Burnham.

Add Alan Milburn and Frank Dobson to the list of Health secretaries since 97 and it's very obvious that Labour couldn't have had stability as a priority for the NHS/DH particularly given the huge changes being made and corresponding increases in funding - some of which amounted to a cash handout to many observers - take this is from the DH website announcing funding in December 2002.

Milburn's reign was particularly notable for generosity with the nation's purse.

"Mr Milburn announced the allocation of the £148.3 billion to Primary Care Trusts (PCTs) over the next three years - this represents a cash increase of 30.83%"

No doubt with PCTs awash with cash in the years that followed - improvements in waiting times were made, but long term systemic changes and efficiencies?? - sorry we just haven't seen it.

No wonder the Treasury was nervous this time round over GP commissioning - but at least they were talking to a man who has spent a large proportion of his political life meeting patients, clinicians and managers on the shop floor.

The Tory Health manifesto published in Jan was also pretty clear about its objectives to de-layer the NHS.

http://tinyurl.com/milburn-cash-handout

Devil in the detail

13 Jul 10 20:03

(bonkers) Has made an important point overlooked by other commentators - GP's are independant contractors, not NHS employees.

I also agree with the additional statement that whilst PCT's are not perfect, there is a need to reconcile the proposed disbandment of the PCTS with the fact that the most economic approach to implementing this strategy can only be acheived with support through the retention of some of the services presently provided, by the combination of PCT's / Shared Services / Health Informatics Services etc.

These include, development of integrated health and social care agendas, central administration and oversight for GP computer standardisation, central coordinated guidance and oversight for Information Governance and Data Security standards with general practice to name a small number.

entering into this proposed approach there is at least a need for some form of organisation with audit responsibility and oversight for what represents an handover of large sums of public money to small 'commercial' enterprises, to ensure that best value for money is achieved, and that standards of care and service delivery continue to be developed positively.

I cannot help but feel the proposal will not result in the abolishment of PCT's altogether, the devil will no doubt be in the detail..

Dont know whats going on?

14 Jul 10 09:13

I used to work for the PCT, they aren’t the best but who is the best? I can tell one thing for sure that PCT’s really had to push GP Practices to provide a better and safer experience to patients. I used to be going around 54 GP Practices, out of 54 only 10 GP Practices were providing the care required to patients.

Keeping this in mind, would you really want GP’s to take over PCT’s…. in my own personal view, a cost cutting approach is being taken to double the implementation cost.

PCTs

daryl.mullen@nhs.net

14 Jul 10 10:54

To the user who commented "out of 54 only 10 GP Practices were providing the care required to patients". You will need to be more specific otherwise people will regard it as unsubstantiated hearsay. Is this actual care or simple PCT box ticking nonsense with no actual link to patient outcomes? Our PCT told us our infection control was inadequate (and hence care to patients) -why, because like nearly every practice we have carpeted areas and toilet brushes in the toilets. Presumabley they wanted hard surfaces for the elderly to fall on and a toilet cleaner employing 12 hours a day. PCTs were a complete waste of scarce resources employing legions of staff with no actual involvement in patient care. What really annoys us at the coal face is people being paid to tell us how to do our job who don't do our job and have no idea of the realities we face every day.

Incompatibles

14 Jul 10 12:11

Lansley seems to have forgotten that implementing major change costs money in the short term (2 to 3 years), balances out in the medium term (3 to 5 years) and, if successful, potentially makes savings in the long term (5 to 10 years). It simply cannot be done at the same time as significantly reducing costs, unless major reductions in front-line services take place. I fear he has accepted the latter as inevitable, but lacks the guts to say so.

Time to move the deckchairs again

14 Jul 10 15:17

All aboard! - Here we go again, get your tickets for a voyage into the unknown.

As an SHA Manager - one of the many currently in the cross hairs of Andrew Landslys 12 bore rifle - I would urge you, like me, to book your seat on the NHS Landsley as we set sail in to unchartered waters.

The trip will undoubtedly be an exciting and precarious one, as we attempt to negotiate the rapids of reorganisation and the shallows of GP Commissioning. We may even run aground on the rocks of redundancy.

Funny thing is though I'm sure I've been on this trip before, in fact looking back at my old souvenirs, I still have reminders of the exotic Purchaser/Provider expedition to the wilds of the internal market. Fortunately for us, all those dangerous “entrepreneurs” were safely returned to the sanctuary of the new GP Contract several years ago. However, captivity is dangerous and I’m sure that it is only a matter of time before a well meaning gate-keeper opens the cage and lets them out again to create more mayhem.

I like many of my fellow passengers set sail years ago on the Good Ship CCMG, transferring first to the SS NHS Executive, and the Blue Ribbon NHS IA before being boarded and scuttled by the Pirate Ship Jolly Richard (CFH) It now seems that the voyage may actually be over, no more will we re-arrange the deckchairs the better to enjoy the view.

It’s one thing to be shipwrecked in uncharted waters; it’s an entirely different thing to be torpedoed by your own government. RIP NHS Healthcare.

Money

lyn@e-health-media.com

14 Jul 10 15:18

Lansley was asked about how many jobs he thought would go and what he thought that would cost at the press launch. He was quite tetchy about the jobs issue, and basically said he couldn't tell because he wanted local health economies to sort out little details like how the white paper will play out on the ground.

He did, however, remind everybody that the NHS has been asked to put aside 2 per cent of its allocation this year for non-recurring expenditure. So that might go on the costs of the shake-up. Although it might also go to the DH to ensure 'financial stability.'

Clarification on comment 9

danish.jafri@medway.nhs.uk

15 Jul 10 09:41

In my comment ( comment no.9) I was referring to another PCT not to MEDWAY PCT. I have been receiving some emails asking for clarification which PCT I was referring to.

Just saying what I have observed and seen in my past job, no offence to any GP Practice.

Here we go again

16 Jul 10 08:34

Another round of expensive re-structuring, more anti NHS managers media, more finger pointing...

Mr Mullens is fairly typical of many who seem to miss the point. What does your PCT do for you and your patients? Many would say nothing, as Mr Mullen seems to suggest.

Then ask yourself;

Who supplies your IT?

Who supports you to secure your data?

Who supports your IT infrastructure?

Are your systems better than (say) 10 years ago?

Who manages your Freedom of Information Act requests (many PCTs get several 100 a year - they will be coming your way soon...)?

Who supports you with Comms plans when you have a SUI?

Who supports you when you have a serious outage?

Who supplies all the data you'll need to plan your services?

Who sorts out the complex contracts with Acutes?

Who rolled out choose and book (yes, you might hate it, but everything will be going through it shortly - you will have no choice)?

I've fired those off without really thinking too hard, am sure many more could contribute.

I'm assuming none of the these will be going away any time soon, in fact FoI looks like becoming a wider piece of law.

So what is likely to happen? The collabatives will form & employ... yes... managers... so instead of one big body, they will be 3 or 4 per patch - thats 3 people doing the job that one will be doing now. Cost cutting? I hardly think so.

And lets be honest, will a collabative have the muscle or skills to re-negiotate a contract with a big accute?

Many of us in PCTs have worked hard to improve systems, processes & procedures across our patches, often working many more hours than we are actually paid for, working weekends, working evenings.

To simply label the PCTs as a waste of resource misses the point.

Economic backlash

16 Jul 10 08:55

How will the economy in general fare as legions of NHS Managers join the unemployed? There will be the loss of their tax revenue (most at 40%), the loss of their spending power and they will need to claim unemployment and other benefits.

I accept that the numbers of managers are excessive and a reduction is needed but is Mr. lansley throwing the baby out with the bath water?

Oh yes, and what about their collective knowledge and skills - going to end up in private companies charging the NHS for their experience at a greater cost than keeping them in their jobs no doubt.

FOI

16 Jul 10 10:06

yes, that's an interesting point.

Will the new GP consortia be "public authorities", accountable for the billions that they spend?

Will they then be required to respond to FOI requests?

I'm guessing there will be many unhappy and suspicious about cost-saving and inevitable rationing decisions made by the consortia. FOI requests could be aplenty.

And who within the consortia will be responsible for answering them?

I could do a better job of cutting costs

davidpalmer24@hotmail.co.uk

16 Jul 10 11:16

Anyone who works with the NHS knows that this idea is NUTS! If we need an example of what happens when you let GP's organise things have a look at the case of a collective of GP managed services called "Take Care Now" who provided out of hours service. http://www.guardian.co.uk/society/2010/jul/15/german-medical-authorities-daniel-ubani Doctors are good at things medical and so it should be, so what will they do if this system is brought in, they will have to hire the very same people currently employed by SHA's and PCT's. However, they will lose the economies of scale and the ability to strategically create and locate services. The bottom line is it will cost more and it will deliver a poorer service. Don't get me wrong I am all for cutting costs but not in this way.

OOH

16 Jul 10 13:20

The local GPs were not the ones who commissioned TCN as the OOH provider. The local PCTs did that. My understanding is that GPs had repeatedly expressed their concerns to the PCT - but the PCTs continued to use TCN.

The PCTs had "limited understanding of the service and did not monitor performance adequately", reporting of activity to PCTs was "not clear and transparent", and TCN grew "without the clinical governance in place to ensure the quality of its services".

"Out-of-hours services were a low priority for PCTs, reflecting the national position at the time", changes to services at PCT level were "often discussed and agreed by non-clinical staff", and none of the PCTs had "robust arrangements" to share information on poorly performing doctors.

Whether the GP consortia will do a better job at ensuring high quality OOH care will have be seen, but the responsibility for the quality of OOH care was, and still is, that of the PCT. Some just don't listen to local GPs and their concerns.