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Many PCTs 'are ill-prepared to implement new contract'

Many primary care trusts are 'ill-prepared' to implement the new contract and some have decided 'their priorities lay elsewhere', an Audit Commission survey reveals.

Research by the public spending watchdog found one in three PCTs lacked the management capacity and finance staff to cope with the contract.

But the commission also found evidence trusts had chosen to dedicate management time to acute trust deficits and hospital waiting lists rather than GPs.

The study, 'Transforming Primary Care', revealed nearly one trust in four had not agreed a plan for contract implementation by last October. Some 11 per cent 'did not then have any future plans for out-of-hours services'.

It also found huge disparities in the level of support PCTs in England gave to their GPs which 'raised questions' about trusts' ability to take on new responsibilities.

On average PCTs devoted one staff member to every 25 practices, but one trust only allocated one person for every 78 practices. Of the nine PCT sites visited as part of the study only three were fully engaging with GPs and practice staff.

'PCTs reported some reluctance among GPs to participate in the PCT agenda, and GPs expressed doubts about whether it would lead to better services for patients,' the commission concluded.

Trusts highlighted taking over responsibility for out-of-hours and lack of capacity as their main challenges in implementating the GMS deal.

More than 40 per cent said financial management was their biggest challenge. One PCT in four said commissioning enhanced services was the major worry.

Dr David Jenner, GMS contract lead at the NHS Alliance, said the timetable for contract implementation had been too fast.

'We've had Carr-Hill, MPIG, delay after delay on a tight timescale, mistakes on global sums and MPIGs, not enough money for IT and out-of-hours. If planning for implementation had proceeded the ballot it could have been achieved,' he said.

The NHS Confederation said the scale of the challenge facing PCTs was 'enormous'.

Andy McKeon, managing director of health at the Audit Commission, said trusts may have improved since the survey was carried out.

PCTs' contract preparations – October 2003

l91 per cent had an agreed work programme to manage the implementation of the new contract

l76 per cent had agreed a programme with practices to discuss how to implement the new contract

l81 per cent had held discussions with some or all of their practices on implementation

l37 per cent of PCTs reported they were 'well or very well prepared' to implement the new contract

l41 per cent of PCTs reported they were 'confident or very confident' they would

be ready to introduce new contract

elements for PMS

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