PCT — foundation hospitals

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Yet another area set to have huge implications for PCTs will be the appearance of NHS foundation trusts. By April 2005, around 40 hospitals should have achieved foundation trust status. Critically different for PCTs, service level agreements (SLAs) are now replaced by legally binding contracts. It is not our intention here to describe this initiative in any detail but this is an area that NHS influencers probably do need to be knowledgeable about.

Note that some commentators have criticised PCTs’ lack of engagement in this major reform, suggesting that the foundation hospitals have been making all the running. If PCTs do not get more involved in the foundation trust debate, they risk becoming marginalised and seeing their role and the influence in primary care eroded in the future, according to Professor Kieran Walshe, professor in health policy and management at Manchester University’s Centre for Healthcare Management. Professor Walshe believes that once foundation hospitals are up and running, they will start to drive real changes in the way that local health economies work. He sees both risks and benefits for PCTs.

The biggest risk is that acute care-focused foundation hospitals will be able to strengthen and reinvigorate the control and influence that hospitals have always exercised within the local health economy, drawing in more resources from primary care. No longer answerable to strategic health authorities, foundation hospitals could soon be new entrepreneurial providers of many community-based services effectively becoming competitors to PCTs in some service areas, he suggests. But there would be benefits too. Those PCTs working with enlightened foundation trusts will have new opportunities to reconfigure services, shifting them towards local needs and priorities and helping to break down barriers between primary and secondary care. Professor Walshe looks forward to foundation PCTs, posing the possibility of a merged foundation hospital and foundation PCT akin to some of the US health maintenance organisations. He also suggests that the most important lesson of the last two decades of healthcare reform is that off-the-shelf, shrink-wrapped, blueprint solutions, rolled out rapidly to a national timetable often do not work. It is often local creativity and initiative that brings forward the most dynamic organisations…