GP engagement with PCTs

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There appears to be some anxiety that GPs are not sufficiently engaged with the NHS reforms and are becoming increasingly reluctant to play an active role in their local PCTs. Shifting the balance of power initiated the transfer of power to the frontline of the NHS, but many doctors say it does not feel as if that is happening on the ground. The NHS Alliance, in its report Engaging GPs in the new NHS and commissioned by NatPaCT, recommended radical solutions. Currently, there is a drift away from the ‘three-at-the-top’ model of partnership and instead it is too often assumed that power lies entirely with the chief executive and lay chair — this must be reversed, says the Alliance. The report recommended that PCT professional executive committee chairs should be re-named chief clinical officers. NHS Alliance chairman Dr Michael Dixon said:

‘We must bring back the enthusiasm and passion GPs once held as commissioners, fundholders, locality commissioning pilots and PCGs. We must empower the GP leaders within our PCTs, who currently feel that they are sidelined or neutralised. We must ensure that the frontline feels ownership of the aims and objectives of the PCT. For clinicians the PCT must become my PCT not their PCT.’ See www.nhsalliance.org.

Such calls to involve PCT clinicians more in decision-making have led to the setting up of a consortium of the NHS Alliance, the General Practitioners Committee, the National Association of Primary Care (NAPC) and the Royal College of General Practitioners. This consortium has issued a joint position statement calling for a ‘continuous line of clinical engagement from PCTs to SHA level’ and suggested that SHAs should co-opt PCT PEC chairs for part of their time

Another report from the NHS Alliance has suggested that more than half of GPs and other primary care staff will resign from PCT posts in the next two years because of ‘stifling bureaucracy’ and workload pressure.

There was an interesting letter in the Health Service Journal from a GP fed up with life under New Labour. He said that he now understood for the first time the nature of the schism between doctors and managers and referred to the ‘fatuous pseudo-Marxist concepts that infest every corner of the system,’ and ‘neo-Maoist three year plans’ and ‘Orwellian NHS speak.’ ‘You are creating a monolith with all the innovative zeal and entrepreneurial flair of a Soviet tractor factory, this clinician suggested.

Finally, joint research from the Office of Public Services Reform, the NAPC and the DH found that some 40 per cent of GPs felt that they were not engaged with their PCT at all. Interestingly the survey also found that personal medical services (PMS) GPs had significantly better relations with their PCT and felt that the PCT understood their needs much better. Just under 50 of all GPs in England now work under PMS contracts. Note though that the arrival of practice-led commissioning is widely expected to help in the re-engagement of GPs — but we will have to wait and see.

Local delivery plans

Market research has shown that local NHS decision-makers wish for NHS influencers to have a much better grounding in both national and local priorities. The new local delivery plans (LDPs) are therefore key documents for NHS influencers to obtain.

It could be expected that all the national priorities are included in the local delivery plans — mental health, CHD, care of the older people, diabetes, cancer, etc — but that other more local issues will also be discussed. For those NHS influencers working outside key national priorities, it would be important to present to the PCT director of public health and PEC GP chairs the full burden of disease dossier for the relevant clinical area. NHS influencers may need to argue that the particular clinical area is significant and that it should be included in the local delivery plan.

It is hugely important for NHS influencers to understand the NHS planning cycle, which begins each summer for the following year, although this is now going through dramatic change with the introduction of a three-year planning cycle. LDPs should normally be complete by the start of each financial year on April 1st. Product launches in-year may find that resources are not made available.