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Don't let PCT near clinical servers!

The news story 'PCTs don't have the savvy to win hospitals battle' (August 16) describes the Institute for Public Policy Research's concern that PCTs may not be well-equipped to negotiate with acute trusts. In our experience at the NHS National Refractory Angina Centre (NRAC), Liverpool, this concern is well-founded.

In December 2002 the director of specialist services commissioning for Cheshire and Merseyside wrote to the chief executive of our parent tertiary referral centre extolling the virtues of our multi award-winning national angina service. Among his reasons for supporting our service was the argument that our 'patient-centred treatment approach presents a real alternative to other forms of treatment including revascularisation, catheterisation and other invasive procedures including the use of high-cost treatments such as drug eluting stents'.

He went on to recommend that we should be given an opportunity to present our case to the commissioning team but this was prevented by the chief executive.

In response to the commissioner's formal request that funds should be allocated to our service, the chief executive wrote: 'While PCTs may look to move resources from surgery and angioplasty to support the NRAS [sic] it is important that this is part of a strategy which the broader consultant body within the trust would in turn support.'

This exemplifies the disparity of influence that PCT commissioners can encounter when negotiating with acute trusts. In this case the commissioner wanted to fund a service that offers patient-centred, low-risk, low-cost alternatives to high-risk, expensive palliative revascularisation.

His desire to make the service 'integral to the overall capacity planning and modernisation of cardiac services within the trust' bore little weight in contrast with powerful consultants' reluctance to have resources diverted from their departments. The chief executive avoided becoming piggy-in-the-middle by giving consultants the power to veto the commissioner's decision.

This scenario is likely to be repeated across the NHS both within and outside cardiology as commissioners flex their muscles and try to decide for themselves what services they want to purchase on behalf of their patients.

It is inevitable that in the emerging patient-centred NHS, hospital consultants will be reluctant to see themselves as servants.

The 'savvy' the PCTs need is to understand how to behave like customers. If the service you receive is not what you asked for, why continue to pay?

(NRAC has won accolades and national awards for innovation, modernisation, guideline development, safety and service excellence – it has recently moved from the cardiothoracic centre to another trust.)

Dr Michael Chester

Director NRAC

and Consultant Cardiologist

Royal Liverpool and Broadgreen University Hospital NHS Trust

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