Primary Care Trusts
Please click here for my press release on the annoucement to Parliament on 17 May 2006.
There are 302 PCTs covering all parts of England, which receive budgets directly from the Department of Health. Since April 2002, PCTs have taken control of local health care while 28 Strategic Health Authorities (SHAs) monitor performance and standards on behalf of the Secretary of State. PCTs, as statutory bodies, are responsible for delivering better health care and health improvements to their local area and were supposed to be more accountable to the grass roots than their predecessor health authorities (PCTs started as committees or Primary Care Groups of the Health Authority).
They directly provide a range of community health services (such as general practitioner (GP), community and primary care services) and they commission "secondary" care and specialist care from other NHS trusts (such as hospital trusts). Much of their agenda is determined by directives from the SHA - currently for us the Birmingham and the Black Country SHA but shortly to be merged with other SHAs to form the West Midlands regional SHA.
I recently responded to the consultation COMMISSIONING A PATIENT-LED NHS: Choosing the right configuration of Primary Care Trusts for Birmingham, to point out that I am still in favour of reconfiguration to one PCT for Birmingham for the reasons I set out in my response to Birmingham Health Authority’s Consultation on proposals to establish Primary Care Trusts in November 2001.
When it became clear that the structure of primary care organisations was up for consultation in 2001, I was strongly in favour of retaining single constituency based primary care organisations (then known and Primary Care Groups) building on the bottom-up movement of GP commissioning groups. However, when it was determined to impose larger PCTs from on high, and the question became how many PCTs there should be rather than whether we should have PCTs at all, I argued for one PCT covering the whole City coupled with a strong locality focus. Most GPs also supported this position. Instead Birmingham was split into four PCTs based on the boudaries of several constituencies. In my 2001 response, I foresaw the current reorganisation and I also predict now that if the decision is made to go for the apparently favoured option of three PCTs, we will be faced with a further reorganisation in a few years time.
Another consideration in relation to the current reorganisation is that constituency boundaries are due to change at the next general election and a move to three PCTs that would not be co-terminous with the new constituency boudaries would mean a loss of accountablity to elected representatives, who would have more than one PCT covering their constituency. Such a structure would make it more difficult for MPs to liaise and work constructively with the relevant PCT on behalf of their constituents. One pan-Birmingham PCT with clear mechanisms for feedback from the grassroots would create far clearer lines of accountability.
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