PCT Provider Functions: From Pillar To Post

Main Category: Primary Care / General Practice
Article Date: 14 Jan 2009 - 5:00 PDT

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If primary care trusts (PCTs) are to get their provider functions right, they need to focus on patient outcome rather than only following departmental guidelines, the NHS Alliance says.

In considering the future of provider functions, PCTs must be clear about what is needed locally and how to secure integrated care to provide services. This is about taking the opportunity to radically improve community care, not just replicating existing services in a new form.

As PCTs gear up to implement the changes set out in the Department of Health's operating framework, they need to be clear about what services their patients will need in the future, from both primary and community care perspective, so that they can assess the changes required and develop a clear plan for moving forward. A compelling local vision for integrating care around the needs of patients and local communities and driving up the quality of care is a must, not an option.

NHS Alliance chairman Dr Michael Dixon said: "PCT provider services can't go from pillar to post. The Department of Health is saying this is really important and we need to get it right, but simply following departmental guidelines is not enough. We need to make it sustainable and adopt a holistic approach to service provision."

The NHS Alliance believes that securing integrated services and care for patients/ communities is crucial. Service should bring together locally integrated teams, including social care, general practice, pharmacy and the full range of community services currently managed by PCTs. Also, future organisational models should preserve patient choice and demonstrate that the best interests of local communities are being served.

NHS Alliance chief executive Michael Sobanja added: "We need to bear in mind that integrated service delivery is more important than integrated organisations. Our main focus should not be on the organisational shape or design, but on the values that will underpin them. At heart, PCTs should be organisations that are built around the needs of the patients and the wider communities they serve, overcoming the fault lines between general practice and community health services, primary and secondary care and health and social care."

The focus should be on managing the developing provider market rather than a prescriptive guidance on the shape and form of emerging provider organisations.

PCTs must be patient-centre and act as the personal face of the local NHS. They should be genuinely clinically-driven. In practice, successful organisations will bring together the skills and expertise of clinicians and managers to get the best of both worlds.

PCT provider services - key points

- PCTs must first decide what they want and then construct the pathway to get there.

- Form should follow function and organisational arrangements should be constructed to reflect this. This could lead to PCTs retaining services in the shorter term (with appropriate governance arrangements).

- PCTs need to be clear as to the future service requirements for primary and community care and have a clear transition services pathway.

- Integrated service deliver is more important than integrated organisations

- Where alternative arrangements are being considered, these should be pursued with due regard for workforce security and in ways that protect services for the future. Primary Care Trusts will need to effectively commission both primary and community services in the future. This will require a clear analysis of the purpose and scope of services articulated in well-thought through specifications.

- Whilst short-term efforts can be made to design organisational models, it should be recognised that the future form of provider functions, outside of PCT management, cannot always be controlled.

- Managing the market is more about setting a direction, for example, building integrated care around the needs of local people and the community, and then ensuring that all local providers work towards this aim. This does not mean one integrated provider - there may be good local reasons for developing a series of parallel providers (PCT provision, including mainly nurses and therapists, an independent primary care provider, urgent primary care provider, social care, hospital trust etc). The role of the commissioner is to be clear and explicit about the outcomes that are expected, all of which require providers to co-operate and work together in the interest of their patients.

- It may be necessary to build on GP computer systems rather than waiting for the national programme to deliver new solutions. While GP systems are far from perfect they are much better placed to begin to measure the outputs and outcomes of integrated local teams.

- Local teams should take responsibility for developing outcome measures to establish whether they are successfully delivering integrated, high quality care for all. Where possible, they should try to develop local systems for effective information management to support the measurement of outcome measures.

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.

NHS Alliance

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