In October 2000, in response to proposals to amalgamate the Selly Oak and Hall Green Primary Care Groups (PCGs) into one Primary Care Trust and the Government’s proposed abolition of Community Health Councils (CHCs), I drew up a draft letter addressed to the Minister of State at the Department of Health.   This was then circulated for comment to each of the thirty-three GP practices in my constituency, the Chair of the South Birmingham Community Health Council, the Chair of the Birmingham Health Authority, the Chief Officer of the Primary Care Group, a former CHC secretary and local councillors.  Fourteen responses were received and a summary of each of these is given in Appendix 1 The final version of my letter to the Health Secretary is at Appendix 2 and his reply at Appendix 3.

Ten of fourteen respondents shared my concerns.

Eight thought local sensitivity and responsiveness would be lost because of the greater size of the PCT.

The other two, both GPs, agreed that it would be better if PCGs were retained as currently constituted but regarded the changes as a "fait accompli". In this context, one believed it possible that the larger trusts might be made to work. The other considered that PCGs had not received enough management support in any case.

Other Points Raised:

1. Five respondents agreed that what was being proposed was a return to the health authority situation of the mid-eighties.
2. Two GPs stressed that allowing new systems time to take root is of great importance.

Four of the Respondents did not agree.

One GP neither agrees nor disagrees but made the point that no population size is ideal as a basic unit as different procedures are in more or less demand.

Four respondents commented on the proposed abolition of CHCs.

All of these respondents shared my concerns.

All considered that CHCs should have a future role though three believed that some degree of reform was necessary.

The Chief Officer of South Birmingham CHC considered that the expertise that the CHCs have amassed since 1974 needs to be retained. Both she and a former CHC secretary were concerned that the NHS should be scrutinised by independent organisations and that the proposed Patient Forums and PALS structure may lack such independence.

A city councillor expressed the view that whilst the Health Service should be accountable and there "may well be a place for some revamped CHC" the local authority should take the lead in the scrutiny of local health services.

In his reply the Health Secretary explaines the events leading to the policy of amalgamations and establishing 5 PCTs in Birmingham and, by implication, supported it whilst seeming to take no responsibility for the process. Local responsiveness is considered of vital importance and the proposed larger PCOs are charged with "ensuring a strong locality focus within them so lessons from good practice are disseminated across a wider area". The larger size will give the organisations "the capacity and capability to shape a primary care led NHS, working as advocates on behalf of their patients and communities". The Secretary of State considers that a PCT is a very different structure to a health authority and the proposals "will not seek to reinvent the health authority geographical outlines". The national policy on Primary Care Trusts is still under development and also under consideration are moves to provide accountability through MPs, councillors or the local council. It remains to be seen whether assurances on a strong locality focus will be met.  

As regards patient representation, in February 2001, the Government accepted an amendment to the proposed reforms and intends to establish Patients Councils as "umbrella bodies" that will collectively draw together the individual patients forums to provide an overview of the work of the various trusts in an area, as well as local health needs. This should go some way to meet concerns although it will be important to ensure that members of Patients Councils are independently appointed and representative and build on the expertise within CHCs.

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Letter to Alan Milburn

Alan Milburn MP
Secretary of State
Department of Health
Richmond House
79 Whitehall
London
SW1A 2NS

30 November 2000

 Dear Alan,

I am writing to draw your attention to some matters of concern:

Reorganisation of Primary Care Groups into Primary Care Trusts

I wish to place on record my opposition to the amalgamation of primary care groups in Birmingham and their ultimate designation as Trusts.

Primary care groups evolved from commissioning groups which were GP-led. In my view this was a very welcome development to enable mutual support, specialist development and bench-marking. The main advantages over health authorities were local knowledge and community links.

The proposed amalgamation will, in effect, revert back to the unsatisfactory system that existed in the Eighties i.e. five health authorities in Birmingham. It is then perfectly conceivable that cost-pressures in the future could lead to the formation of an organisation for the whole of Birmingham, taking us back to where we started.

This is not what is required.

Primary care groups at an approximately constituency level involving GP lists rather than rigid boundaries should be retained. These should be accountable to a retained Birmingham Health Authority that should provide administrative support to reduce overheads.

I value the relationships that are being developed between the Selly Oak Primary Care Group, elected representatives and the local community. The influence of GPs and other health-care workers should be rescued and overheads reduced by means of central support from Birmingham Health Authority. Accountability should be through the local MP and councillors and scrutiny through Birmingham City Council, as well as the Health Authority, which should be likewise scrutinised.

Why is the Government set on a structure that will take us back into the mid-Eighties?

The NHS Plan – Proposed Abolition of Community Health Councils

I welcome the proposal that local authorities should have a central role in the scrutiny of the NHS. However, in relation to the patient advocacy and representation role currently played by community health councils, there is considerable concern that the new structures are insufficiently independent.

Patient forums are a good idea but are only likely to retain committed patient involvement where there is a longer-term relationship with the relevant trust. They are likely to be less effective in acute hospital settings.

My understanding is that patient advocates would be employed by the trust. This means that their independence will be compromised. Is there not still a role for revamped and adequately funded community health councils running the Advocacy and Liaison Service, (with outposts in each trust), together with local patient forums covering a geographical area? In a speech just prior to the 1997 General Election, Chris Smith, then Shadow Health Secretary, explicitly rejected a suggestion that CHC’s should give up their patient advocacy role. This would "find no favour whatsoever with a Labour Government" he said.

The Views of Stakeholders in my Constituency

I have consulted every GP practice in my constituency, the Chair of the South Birmingham Community Health Council, the Chair of the Birmingham Health Authority, the Chief Officer of the Primary Care Group and local councillors and I enclose copies of the responses I have received. A summary is being prepared, which I will forward as soon as possible.

Interestingly, the only respondent who does not seem to share my point of view on primary care trusts is the Chief Officer of the Primary Care Group. However, all other correspondents seem to be generally in agreement with my concerns. Worryingly, the sender of one reply felt the need to remain anonymous and another felt that nothing could be done but accept the proposals as a fait accompli. Do you not think that it is very worrying that the Chief Officer is failing to represent the concerns of the GP members of the Primary Care Group?

In conclusion, I would remind you of the contents of a letter you wrote to me on 26^th January 1998 when, as Minister of State, you said:

‘We want a strong public voice in health and health care decision-making, recognising the important part played by Community Health Councils in providing information and advice and in representing the patient’s interest. We attach particular importance to strengthening public confidence in the way major changes in local services are planned. We will explore new ways of securing informed public and expert involvement in such decisions. For the first time there will be a clear set of principals in decision-making and criteria for ensuring that due process is observed.’

I agree with these comments and would ask that you ensure that the principles that you have espoused are put into practice. I hope I have offered some positive suggestions towards achieving this.

Yours sincerely,

LYNNE JONES MP