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GPs 'disenfranchised' in PCT decision-making

The Government claims it has put GPs in the driving seat of the NHS, but new research from the NHS Modernisation Agency shows GPs' scepticism is justified –

Ian Cameron reports

One of the Department of Health's favourite marketing ploys when it wants to win over GP opinion is to hail

the success of its drive to put power back in the hands of clinicians.

Two new initiatives, practice-led commissioning and specialist PMS, are being sold under this very promise.

Before that, the creation of primary care trusts, containing a policymaking professional executive committee of clinicians and managers, was tagged as 'Shifting the Balance of Power'.

But a new study – by the Government's own NHS Modernisation Agency together with the NHS Alliance – has revealed just how little influence clinicians have over PCT decisions and how much GPs should beware of future Government assurances that it is handing over NHS power.

The study of decision making in 56 PCTs in England finds influence over policies is heavily concentrated in the hands of chief executives and managers.

Professional executive committees (PECs) are estimated to have around 30 per cent of influence over policy compared with 40 per cent for the chief executive and senior management of the trust.

When asked to what extent executive committees drove commissioning – on a scale of one to 10, where one is 'not at all' and 10 is 'fully' – most respondents scored less than five.

The result is that professional executive committees are being 'significantly marginalised' and GPs are being alienated and disenfranchised, the report concludes.

'This is not only clearly in breach of the policy of putting primary care clinicians in the driving seat – it is also fundamentally self-defeating,' it argues.

'It is clear that the seriousness and centrality of committee duties was not always understood or enacted in the day-to-day management of a significant number of PCTs.'

Dr Ken Aswani, a GP in Leytonstone, east London, and NHS Alliance spokesman on the issue, said GPs involved in around a quarter of PCTs felt 'disempowered'.

He added: 'There are committees where clinicians don't feel they are driving the agenda and they don't have influence. Quite frankly they are not the engine room of the organisation.

'Transformation of the NHS and service redesign will only occur from successful PEC leadership, and without it that transformation is going to be much slower.'

Dr Lis Rodgers, PEC chair of Doncaster West PCT, said she knew of trusts that were ignoring clinician's views and predicted they would 'come a cropper'.

She added: 'I would absolutely not want to be a committee chair in some PCTs I know because I would be marginalised.

'There is no clinical engagement in any policy developments or pathway developments and as a result clinicians feel badly done by.

'Any organisation that redesigns pathways without clinicians' involvement will eventually come a cropper as clinicians have a great capacity to sabotage any practice if they are not satisfied.'

The Government admits it is aware of some of the problems. Advisers also concede the situation is being made worse by undue pressure on PCTs from strategic health authorities.

Paul Stanton, acting director of board development

programmes at the National Clinical Governance Support Team – which jointly sponsored the new research – said health authorities were guilty of continual interference. 'There is a gradual change but strategic health authorities themselves have taken time to mature,' he said.

'PCTs can't work without professional executive committees but that message has not got through to health authorities. The vast majority of trusts felt they were not supported.'

The result is power is not even residing in the trust, never mind the GPs who are trying to influence its direction.

Dr James Goodman, professional executive committee chair of Wyre Forest PCT, said strategic health authorities were hampering PCTs' development.

'In relation to commissioning and developing new models of care, health authorities don't understand what PCTs or executive committees are,' he said. 'They are telling us where to put money, how to spend it and what targets to aim for. The PEC should be the major influence wielder.'

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