“Clusters” of primary care trusts will oversee transition to new NHS

BMJ 2010; 341 doi: (Published 17 December 2010) Cite this as: BMJ 2010;341:c7286
  1. Andrew Cole
  1. 1London

England’s 151 primary care trusts are to be reorganised into fewer, larger “clusters” by next June to help the transition to the restructured NHS outlined in the white paper Equity and excellence: liberating the NHS.

In its operating framework for 2011-12, released on 15 December, the Department of Health says there will be a “managed consolidation” of primary care trusts across all NHS regions before their abolition and replacement by general practice consortiums in 2013.

However, in a letter to the Times, David Martin, a doctor from Newark, points out that “almost buried in the detail” of the framework is a “safety valve clause” that says the clusters “may continue to function beyond 2013 ‘if the NHSCB [the proposed NHS Commissioning Board] chooses’” (Times, 17 Dec). He adds, “So, if the pathfinder GP commissioning consortia do not work out as the successors to PCTs [primary care trusts], the essence of the present commissioning management structure, appropriately modernised, may remain in place.”

The main role of the new clusters, says the framework, will be to oversee delivery of services and support the emerging consortiums with funding and commissioning expertise, and then close themselves down.

Each cluster will have a single executive team and must be in place by June 2011 at the latest. They will remain in operation until April 2013 “and potentially beyond if the NHS Commissioning Board chooses.”

The new GP consortiums will receive £2 per head of population—derived largely from management cost savings—to support their development. Primary care trusts will also be expected to provide a senior finance manager and experts in commissioning, organisational development, and governance and corporate affairs.

The framework also reveals that the NHS Commissioning Board—which will take over from strategic health authorities and oversee the running of the service—is to be set up in shadow form next year before taking over in April 2012.

NHS chief executive David Nicholson admitted that the changes were “perhaps the most significant and complex that the NHS has faced.”

The next financial year would be “critical” in laying the foundations for the new system. Managers and clinicians will have to balance three sometimes competing priorities—maintaining and improving the quality of services, making big efficiency savings, and making progress on the transition.

The NHS will be expected to improve performance in a number of areas during this transition period, including cutting hospital acquired infections, reducing readmission rates, and maintaining, or where possible improving, the waiting times between referral and treatment.

The framework also revises the timetable for the £15-20bn (€18-24bn; $23-31bn) efficiency savings, which must now be achieved by March 2015 rather than, as previously stated, March 2014. This has been made possible by “the strong financial settlement and early action on pay restraint.”

Meanwhile, primary care trusts have been told to hold back 2% of their budget to help fund the reforms. Hospitals will again only receive the marginal rate of tariff above baseline thresholds for emergency admissions, and the national tariff efficiency requirement will be set at 4%. Mr Nicholson accepts that these measures will create “real challenges” for some parts of the service.

If staff agree to forego their pay increments over the next two years, they will be rewarded with greater job security, the framework adds. Any savings will be retained by employers “to enable them to protect staff from avoidable compulsory redundancies.”


Cite this as: BMJ 2010;341:c7286


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