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'Immature' trusts threaten contract

The head of the Department of Health's strategy unit has admitted there are 'real issues' over the capacity of PCTs to implement the new contract.

Professor Chris Ham called on GPs to be 'realistic' over how long it will take trusts to recruit and develop staff to implement 'something so complex' as the GMS deal.

His comments came after a major report on NHS reforms under the Labour government concluded PCTs were not mature enough to cope with the challenges of the contract.

The research by the Nuffield Trust think-tank also concluded trust managers did not have the negotiating skills to stop debt-ridden hospitals swallowing money meant for primary care.

Professor Martin Roland, director of the National Primary Care Research and Development Centre and author of the report's chapter on PCTs, said the volume of work involved in the new GP contract would 'severely stretch organisations that were already struggling to cope'.

He added there was a risk experienced hospital managers would 'shout louder' than GPs when trusts had to choose how to spend their money.

Professor Roland said: 'PCTs do not appear to have the management capacity to challenge the major secondary care providers to whom most of their resource goes.'

Professor Ham said PCTs had only been in existence for 18 months and he was confident that when they had time to mature they would deliver.

But Dr Charles Simenoff, a member of Manchester LMC executive, said GPs would 'bear the brunt of PCTs' immaturity'. He added: 'They haven't got the staff, money or expertise. We are naïve if we think any extra money we will end up with us just because it is going into primary care.'

Dr Phil McCarthy, chair of Avon LMC, which has lost out on £1.4 million for enhanced services because of massive hospital debts, said GPs were often at odds with PCTs over funding. He said: 'Much of the money that should have come to GPs has been diverted to hospital debt.'

The Nuffield Trust report recommends PCTs join together to form commissioning networks. It also said PCTs should not base decisions on Government star ratings.

Dr Mike Dixon, chair of the NHS Alliance, said it was unfair to say PCTs 'did not have the competence' to deliver the contract. He said: 'What they don't have is the maturity, time and resources.'

 · Default contract, page 2

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