Feature NHS Reorganisation

Goodbye (and good riddance?) to PCTs

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2039 (Published 02 April 2013) Cite this as: BMJ 2013;346:f2039
  1. Richard Vize, freelance journalist
  1. 1London, UK
  1. richard.vize{at}gmail.com

As England’s primary care trusts give way to clinical commissioning groups, Richard Vize pens their obituary. Did PCTs make a difference to inequalities of care, reduce the dominance of acute providers, or make primary care safer for patients?

Did primary care trusts improve healthcare? It took just 13 years for them to be created, merged, clustered, and abolished. During that time they were responsible for about 80% of the NHS budget in England.

The original 303 PCTs across England began taking over from district health authorities and primary care groups in 2000. In 2006 they were merged to form 152 organisations and instructed to begin withdrawing from running community services—known in the artless syntax of Whitehall as “separating out their provider arm”—to focus on commissioning. As the local “system leader” they were charged with driving up quality, improving public health, and reducing inequalities.

In 2010 the health select committee delivered a devastating critique of their commissioning performance, condemning them for failing to tackle quality issues such as variations in clinical practice. It attributed their weaknesses to their “lack of skills, notably poor analysis of data, lack of clinical knowledge, and the poor quality of much PCT management.” All this was exacerbated by the Department of Health’s imposition of constant reorganisation, it added.

Lack of power

One of the myths of commissioning is that commissioners wield considerable power. The macho rhetoric of the Department of Health gave the impression that the relationship between commissioners and providers was increasingly one of equals as PCTs ramped up their skills and confidence, fired by the hyperbole strewn world class commissioning development programme.

The reality is that the providers have always been in charge. While in theory PCTs could strip poorly performing services of their contracts and award the work elsewhere, in practice commissioners were generally faced with …

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