Primary Care Trusts
May 2006
Please click here for my press release on the
annoucement to Parliament on 17 May 2006.
April 2006
Background
There are 302 PCTs covering all parts of England, which receive budgets
directly from the Department of Health. Since April 2002, PCTs have taken control of
local health care while 28 Strategic Health Authorities (SHAs) monitor performance and
standards on behalf of the Secretary of State. PCTs, as statutory bodies, are
responsible for delivering better health care and health improvements to their local area
and were supposed to be more accountable to the grass roots than their predecessor health
authorities (PCTs started as committees or Primary Care Groups of the Health Authority).
They directly provide a range of community health services (such as
general practitioner (GP), community and primary care services) and they commission
"secondary" care and specialist care from other NHS trusts (such as hospital
trusts). Much of their agenda is determined by directives from the SHA - currently
for us the Birmingham and the Black Country SHA but shortly to be merged with other SHAs
to form the West Midlands regional SHA.
Consultation 2006
I recently responded to the consultation COMMISSIONING A PATIENT-LED NHS:
Choosing the right configuration of Primary Care Trusts for Birmingham, to point out
that I am still in favour of reconfiguration to one PCT for Birmingham for the reasons I
set out in my response to Birmingham Health
Authority’s Consultation on proposals to establish Primary Care Trusts in November
2001.
When it became clear that the structure of primary care organisations was
up for consultation in 2001, I was strongly in favour of retaining single constituency
based primary care organisations (then known and Primary Care Groups) building on the
bottom-up movement of GP commissioning groups. However, when it was determined to impose
larger PCTs from on high, and the question became how many PCTs there should be rather
than whether we should have PCTs at all, I argued for one PCT covering the whole City
coupled with a strong locality focus. Most GPs also supported this position. Instead Birmingham
was split into four PCTs based on the boudaries of several constituencies. In my 2001
response, I foresaw the current reorganisation and I also predict now that if the decision
is made to go for the apparently favoured option of three PCTs, we will be faced with a
further reorganisation in a few years time.
Another consideration in relation to the current reorganisation is that
constituency boundaries are due to change at the next general election and a move to three
PCTs that would not be co-terminous with the new constituency boudaries would mean a loss
of accountablity to elected representatives, who would have more than one PCT covering
their constituency. Such a structure would make it more difficult for MPs to liaise and
work constructively with the relevant PCT on behalf of their constituents. One
pan-Birmingham PCT with clear mechanisms for feedback from the grassroots would create far
clearer lines of accountability.
Previous postings on this issue:
November 2001
February 2001
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