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PCTs – Mission impossible for 2003?

SO WHAT IS IT that will be keeping PCTs, their Chief Executive’s and other members of the team awake at nights? This table gives some idea of the breadth of the agenda faced by PCTs and is by no means exhaustive nor is it in any particular order. Let’s have a look at some of the issues in greater detail:

1. Financial Management This might sound odd at a time of record investment in the NHS, but for many the name of the game will be to balance the books. Whilst the new money is welcome, it comes with strings – national priorities and developments, of which there are many – see section 9 below. For others, the task will be to spend the money wisely and in ways that really make a difference to patients by both improving outcomes and improving patient experience of the NHS. The NHS, and particularly the acute sector has a seemingly insatiable appetite for soaking up money without demonstrable benefits – perhaps just catching up on the decades of under-investment means this is inevitable. One of the real problems faced here is that for some the big resource limiter will be the absence of people, and not money. We are entering a phase of development where thinking imaginatively around the use of the work-force will be far more important that funding difficulties. The new allocations have also been followed by advice as to where PCTs sit with regard to target allocations – some with a distance from target of 30% – a huge variation to plan for.

2. Performance indicators The big issue here is that this year PCTs will be star-rated for the first time – often on issues outside of their immediate control. Being star rated on issues like suicide and infant mortality can be tough, and many of the other indicators mean PCTs taking responsibility for what appears at first glance to be the responsibility of others – discharge arrangements from hospitals are a good example. But if PCTs are to be the central linchpin of the NHS then they must face up to this key role of pulling it all together and delivering to populations and patients. Make no mistake, the ability of some chief executives to achieve star ratings will mean the difference between keeping their job or not, and may mean the difference between the organisation being swallowed up by some of the higher performing organisations in the area.

3. Engaging professionals Remember the political rhetoric of 1998-9? Primary care organisa-tions were to be run by the front line with “Doctors and nurses in the driving seat”. A few years on and many PCTs are witnessing profes-sionals walking away in droves. There are many reasons for this but perhaps a dawning realisation that Primary Care Trusts are the new bureaucracies is at the centre. Bigger, more managed organisations with statutory responsibilities have a hard time being inclusive friendly bodies and it is showing. The cynics say that the metamorphosis from PCT to HA and Strategic HA to old region is pretty quick, but whatever the reality this is coming at a time when PCTs are going to have to tackle one of the biggest NHS jobs of all time – implementing the new GP contract, on top of everything else and trying to engage all clinicians – dentists, optometrists and community pharmacists to name but a few.

4. Engaging the public The difference between PCTs and yesterdays Health Authorities can probably be measured in two key ways – how effective they are in engaging professionals (see above) and how effective they are in engaging the pubic – patients and populations alike. A whole plethora of new bodies is starting to emerge, Patient Advocacy and Liaison Groups. Public Forum, and the Commission for Public and Patient Involvement in Health but the real test will be whether the woman in the street is heard and listened to. Will these new mechanisms make a difference? Is the new NHS prepared to share decision making with the public? Or will it be another round of tokenism and disillusionment – I think not – but it will be down to PCTs to make the difference.

5. Developing commissioning Let’s face it – commissioning has gone backwards not forwards. Intended to be the basis for a new partnership between primary and secondary care, it has all too often become the squabbling ground or the one where the PCT became preoccupied with its own organisational change and took its foot off the commissioning accelerator. Ministers expect some pretty big changes here and see commissioning as being a key delivery mechanism. Of course, life wouldn’t be the same with-out some substantial change to cope with so the new financial changes, with the introduction of national tariff pricing and patient choice will test many to the limit. We had just got used to commis-sioning again when the politicians became impatient and decided to re-introduce purchasing and a competitive edge to the game. Finally, we are just coming to terms with the realisation that commissioning in the future will mean the commissioning of primary care as well as sec-ondary care services.

6. Working together I’ve already touched on this – working together with acute trusts is one thing, but have a look at the partnership list of potential bodies NHS must work with effectively to achieve success. One PCT Chief Executive I know has his list up to forty three – and only manages to keep it that low by counting the voluntary sector as one. So there is a very real challenge to create partnerships that involve all stakeholders and deliver the goods in terms of health improvement.

7. Overview and Scrutiny Committees Of course, a key partner in the health community is the local author-ity, but they are about to become a key assessor as well. Potentially the most demanding of the new accountability mechanisms (don’t forget CHI – whoops sorry CHAI from 1 April) Local Authority Overview and Scrutiny Committees will start to get their teeth into the NHS – and some old scores will be settled as well.

8. National Service Frameworks Delivering National Standards was one of the big ideas for New Labour and we are now on the never ending National Service Framework merry-go-round. Personally, I’m a fan – about time too that we had some national standards in place – but don’t underestimate their impact and the difficulty in sustaining improvement. The easy stuff has been addressed – now we are down to the hard slog of main-taining initial momentum – and addressing the new ones – like the Diabetes NSF – even if it was watered down – that will mean a huge new challenge for PCTs. And the world will not stand still over the next three years. There will for example be the new National Service Frameworks for Children and Renal Services and the delivery of that for Diabetes.

9. Delivery the national agenda One of the big plusses for 2002 was the switch to three year plans, financial allocations and planning guidance. This was remarkably suc-cinct and tells PCTs in clear terms what they have to do up to 2006.

The priorities are clear:

  • improving access to all services through:
  • better emergency care
  • reduced waiting, increased booking for appointments and admission and more choice for patients
  • focusing on improving services and outcomes in:
    • cancer
    • coronary heart disease
    • mental health
    • older people
  • improving life chances for children
  • improving the overall experience of patients
  • reducing health inequalities
  • contributing to the cross-government drive to reduce drug misuse

In addition each NHS organisation, working with its local councils and other local partners, will need to develop underpinning plans which show the total increases in capacity in the three key areas of:

  • physical facilities
  • workforce
  • information management and technology

The challenge of creating a three year delivery plan will be only out-stripped by the ability of PCTs to deliver… Finding space for the local agenda This might be seen as an offshoot of national priorities. The PPF guidance is quite clear. “ Other than the targets in this document, arrangements for delivery will be a matter for local determination. Local organisations and com-munities will set their own timescales and milestones. They will be responsible for reporting to and accounting to their local communities for improving these services where necessary” All very well, but when do PCTs find the time? My concern is that there will be little space for local organisations to address local needs.

Conclusion I was tempted to use the phrase “If you are not confused…you don’t know what’s going on…” but in reality, it is a question of knowing what’s going on at a local and national level. This is a big challenge but one which field staff can get to grips with – start by applying the ten challenges above to the local scene and does some environmental mapping. NHS knowledge was at one time the preserve of the spe-cialist NHS liaison manager – these days it is a vital tool for all sales professionals to use in a changing customer environment. Michael Sobanja Director of NHS Alignment – HealthGain Solutions Chief Executive – NHS Alliance Michael Sobanja writes personally, he takes personal responsibility for the views in this article that may not represent the views of either organisation mentioned above

The top ten key issues for PCTs in 2003

  • Financial Management
  • Performance indicators
  • Engaging professionals
  • Engaging the public
  • Developing commissioning
  • Working together
  • Overview and Scrutiny Committees
  • National Service Frameworks
  • Delivering the national agenda
  • Finding space for the local agenda
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