PCT Provider Services: Don't Rush To Divorce

Main Category: Primary Care / General Practice
Also Included In: Public Health
Article Date: 03 Nov 2008 - 2:00 PST

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The separation of provision from commissioning has been one of the hallmarks of NHS policy in recent years. A corollary of that has been an assumption that it is preferable for PCT provider services should be separated off into stand-alone services.

That is not necessarily a good idea, the NHS Alliance says. PCTs should stand back and consider carefully what might be lost before rushing to divorce.

A new paper: Provider services and primary care trusts, gives a series of cogent reasons for careful reflection before deciding to divest provision. They include:

- Access to in-house resources allows PCTs to maintain their ability to develop rapid pilots to trial new care pathways and innovative re-design. Swift implementation and evaluation would be delayed if services must be specified and tendered. The evolution of new services according to assessment would be hindered by the need to re-specify.

- The possible takeover of relatively weak provider organisations by Foundation Trusts could result in a further imbalance of power between commissioners and providers, already a problem according to a recent Health Select Committee report. The development of integrated care should be driven by co-operative working rather than by the absorption of nascent provider organisations into hospital-based organisations.

- Separation is likely to result in duplication of functions such as workforce support, finance and payroll, leading to increased costs. While this may be sustainable in urban areas where several provider services might be amalgamated, that is not the case in more rural areas where community hospitals or nursing teams may be anything from twenty to fifty miles apart.

The author of the paper is NHS Alliance vice-chairman Dr Donal Hynes. He said:

"Superficially, the divestment of provider services seems a logical progression of the separation of commissioning and provision.

"But we should not forget that the strategic goal of the policy is to make commissioning more dynamic and focused on population needs, so as to improve the health of the community. Setting up independent provider organisations should be considered in that context.

"As long as effective structures and governance are in place, there is no reason for urgency - and every reason for measured and well thought out decisions."

Notes

1. The NHS Alliance is a collaboration of clinicians, managers and board members who put patients first. It is the independent body that represents NHS primary care. Values based, it is the only organisation that brings together PCTs with GP practices, clinicians with managers and Board members, and NHS primary care with its patients. The Alliance membership and its hard working national executive is fully multi-professional.

The NHS Alliance