Theoretically, it made sense – moving commissioning and public health from PCTs [primary care trusts] to the local authorities – but people weren't ready and the skills weren't there initially.
This financial year, around 300 local primary-care trusts (PCTs)—reconfigured local health authorities with GP representatives will control three-quarters of total health spending.
"It would be better to have elected boards on the PCTs rather than on the foundation hospitals," argues Professor Le Grand.
Until now, the criticism has been largely anecdotal, but a report on May 5th from the National Audit Office shows that there is ample reason for patients to grumble.The NAO found that many PCTs are failing to meet quality requirements set by the government for the out-of-hours service.
A new body, an independent commissioning board, would be established to advise and monitor the consortia, and would itself purchase dentistry, pharmacy and ophthalmic services.Once budgetary control has been handed to GP consortia, the ten strategic health authorities and around 150 PCTs are to be abolished.
Indeed the NAO complained that such difficulties meant many PCTs found it hard even to gather meaningful figures for its survey.
Replacing 95 health authorities, they will control three-quarters of the NHS budget by 2004.In principle, this should drive better and more effective provision of health care as the PCTS act as more effective agents for their patients.
Services once run by PCTs, such as district nursing, will shift, and in some cases be provided by staff who leave the NHS to form not-for-profit outfits.
Primary-care trusts (PCTs), the 300 local organisations that purchase hospital treatments, could face a funding shortfall if hospitals do more work than budgeted for.
PCTs will have to keep their local hospital going in order to deal with accidents and emergencies.Despite these drawbacks, the current plan, with its focus on purchasing and financial incentives, is much better than the original Soviet-style NHS plan of July 2000.
The PCTs have to be strengthened so that they can square up to the powerful hospitals that have held sway since the NHS was created in 1948.
