PCT — primary versus secondary care < Influencers contents | Print this page Primary versus secondary care A particularly high profile at the moment is being given to the secondary care commissioning role of the PCT. This is increasingly being seen as the area where PCTs really do have to work. The balance between hospital and primary/community services in the UK has always been in favour of the acute sector with a chronic tendency of hospital services to suck in resources. This is the real battleground for the modernisation of the NHS and PCTs are expected by government to break this model of an acute sector dominated NHS. Greater Manchester SHA appears to be at the vanguard of a nationwide push to shift the balance of power from secondary to primary and intermediate care. For example there are now some 23 emergency care practitioners helping ambulance crews to refer patients to services other than A&E departments. Essex Ambulance Service NHS Trust appointed a new head of primary care development — this is about the trust providing a new out-of-hours (OOH) service and looking to reduce demands for surgery appointments, A&E attendances and unnecessary ambulance calls. They also want to integrate other primary care services and minor injury/illness into their portfolio of emergency care services. Seventeen new NHS walk-in centres (WICs) are to be set up across England, bringing the total number to 82. WICs provide quick access to advice and treatment for minor ailments and injuries. Among others, new centres are planned for Birmingham, Derby, Leeds, Manchester, Milton Keynes and London (Newham, Ilford, Barking/Dagenham, Romford and Harold Wood). See DH press release 2004/0301 for the full list. In Birmingham, the planned new WIC will be fully integrated with other local health services, including OOH care, and will have an on-site pharmacy. The centre planned for Milton Keynes will support the local general hospital, helping to relieve pressure on A&E services. In addition to the new WICs the Department has set out new plans for the development of six instant access GP-led centres that will allow commuters to access health services closer to their workplace. The first of these centres was announced in the NHS improvement plan in July and are to be sited in Leeds, Newcastle, Manchester and London. Nearly two thirds of the PFI projects will see significant investment in the community as well as acute services. For instance the North Mersey future healthcare project will see the closure of all psychiatric wards in the acute sector and their replacement with five mental health resource centres in community settings. In Sandwell and West Birmingham the new developments will include community-based alternatives to hospital care. This continued focus on hospital disinvestment has got to be important to NHS influencers. The 1,300 or so GPs with special interests are one of the main drivers of this at the moment. Practitioners with special interests Guidance for PCTs and NHS trusts is available on developing the roles of allied healthcare professionals with special interests in primary care. See Practitioners with special interests: bringing services closer to patients. The Department has armed PCTs with a document setting out the level of service they should expect from secondary providers. The document suggests that 50 per cent of outpatients and 40 per cent of those attending A&E do not need to be there. ‘PCTs should use the new evidence to challenge acute trusts’, said Dr David Colin-Thome, national clinical director for primary care. The hope would be that this evidence-based guidance would allow PCTs to ‘slow down spending’ on secondary care, freeing up money for PCTs to spend in other areas. Research is also suggesting that services need to be commissioned at the most appropriate population and organisational level. This might be by PCT consortia but it may also be at GP practice level. This of course was exactly what fundholding was all about and the introduction of practice-led commissioning is of great relevance here. The
national tracker survey of primary care groups and trusts 2001/02 NHS influencers should
still find this publication well worth the read. Previous reports
from the NPCRDC have proved to a be a gold mine for people wanting
to find out in detail how PCTs have evolved and have featured particularly
useful material around prescribing issues. Included in the study
are a number of concerns expressed around the pressures posed by
NSFs and NICE guidance. PCT prescribing leads suggest that the NSF
ideals and real funding levels do not add up and called for more
realistic prescribing budgets — especially as there is now
a statutory obligation to fund treatments recommended by NICE. The
survey’s findings on prescribing also suggest that improvements
seen in previous years may have levelled out. Proton pump inhibitors
and antibiotics remain common areas for attention.
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