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Managers defend PCT performance and legacy

PCTs are unfairly criticised and have helped improve NHS, says report

Adrian O'Dowd

Monday, 11 July 2011

New clinical commissioning groups could learn useful lessons from primary care trusts (PCTs), which have often been unfairly criticised, claims a new report from trusts’ representatives.

A report from the NHS Confederation’s primary care trust network says the achievements of PCTs must be acknowledged if clinical commissioning groups (CCGs) are to be given a good chance of success.

PCTs have overseen the delivery of significant improvements in the health of local populations and the quality of health services in their time says the report The Legacy of Primary Care Trusts, as well as delivering what was asked of them in almost all major policy areas.

The report, which looks at the performance of PCTs since they were established in 2000, looks at both their commissioning and provider responsibilities.

It analyses the areas where PCTs made advances in improving the health of local communities, as well as issues that proved more difficult to tackle, such as health inequalities.

It highlights evidence that shows PCTs were mainly effective at carrying out the duties asked of them, despite being tasked with a greater list of responsibilities year-on-year.

Various successes of PCTs given include:

  • helping to reduce waiting times in England
  • increasing life expectancy at birth for both men and women
  • reducing infant mortality
  • overall improvement in cancer survival rates in England.

The report addresses a range of criticisms often directed at PCTs, such as the debate about whether PCTs are too bureaucratic and managerially-led.

It says: “It is easy to accuse public organisations of being overly bureaucratic. Any publicly accountable organisation needs a degree of bureaucracy, in the sense that they need clear, transparent and consistent decision-making processes, schemes of delegation, standing orders, and so on.

“Where there has been frustration both among PCTs’ own staff and their partners such as GPs, it has often related to the degree of central control from the Department of Health and strategic heatlh authorities.”

PCTs have a significant degree of clinician input, it adds, saying: “On each board, the majority of executive directors for PCTs are clinicians, with three clinicians (including at least one GP) drawn from the professional executive committee, and a director of public health who is either a clinician or trained in public health.

“The other required executive directors are the chief executive (who in some cases is also a clinician) and the finance director. So, PCTs are in fact more clinically led than other parts of the NHS.”

David Stout, director of the PCT network, said: “PCTs have been subjected to much criticism since their establishment, much of which PCT staff feel has been inaccurate and unfair.

“We believe the evidence of progress made by PCTs should be acknowledged so future commissioning organisations and policy-makers can learn from those PCTs that have worked successfully to improve health and NHS services in their local communities.

“New commissioning bodies will face many of the same challenges and pressures as PCTs. If they are to be given the greatest chance of success, it is essential we take a realistic and balanced view of PCTs' work so we can learn the lessons for the future of NHS commissioning.”

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