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What did PCTs ever do for us?

They were bureaucratic, and often ineffective and high-handed, but it turns out PCTs did have one or two uses after all, says Pulse editor By Richard Hoey

By Richard Hoey

They were bureaucratic, and often ineffective and high-handed, but it turns out PCTs did have one or two uses after all, says Pulse editor By Richard Hoey

Not a day goes by at the moment without someone somewhere unearthing something else that is apparently the function of PCTs.

It's almost like they had their managerial responsibilities hidden down the back of the sofa or stuffed under the carpet… even the trusts themselves seemed to have no idea how much they were doing.

All of a sudden a great stack of managerial tasks - whether they be child-protection responsibilities, or appraisal, or this week the administration of the nursing grants to care homes - seems to be teetering in the direction of GP consortia.

The NHS Confederation has has had a stab at counting all the things that PCTs are currently doing, and has come up with a list of around 211 items, give or take the odd duplicate or function so obscure no one's really sure if it still exists or not.

Some of those – like managing public health programmes – will go to local authorities, and a decent chunk presumably be sucked up by the NHS Commissioning Board, but that still leaves an alarming number heading the way of GPs.

It's easy to deride some of the less medical of their functions… the equal opportunities management, perhaps, or the disability access monitoring.

But unless the NHS unilaterally pulls out of the European Union, or exempts itself from the Human Rights Act, then those functions, like all the others, are here to stay.

That's why the BMA has come out and said PCTs should be kept, after all, and why that was the narrow majority view in our recent poll of GPs.

Far easier, goes the argument, to keep the trusts to do the boring stuff, but just give them a new leadership of GPs to take the big commissioning decisions.

There is one massive, unmovable and unarguable reason why that is not, at least on paper, going to happen.

Health secretary Andrew Lansley has staked his reputation on the need to sweep aside PCTs, and it would make more than a decent dose of logic to get him to concede defeat. In public, he has firmly dismissed any idea that he might be for turning.

I'm hearing that is office is rather less assured in private, however, and that it has been more rattled that it will want to let on by the degree of negativity in the BMA's response.

Even figures close to Mr Lansley are apparently suggesting that there could still be a way back, if not for PCTs, then at least for managerial structures looking suspiciously like them.

I'm hearing rumours, and it's still very tentative at this stage, that the branches of the NHS Commissioning Board could be rather more numerous, indeed you might almost say PCT-like, than most of us had been led to expect.

There will still be many less than PCTs, I'm sure, but my guess would be that there will be rather more than there are SHAs, and that they will be doing more than just the core functions of the NHS Commissioning Board described so far.

Enough perhaps to tick off at least a few of the 211 items on that list.

By Richard Hoey is Editor of Pulse magazine

Click here for more Editor's blogs By Richard Hoey, Pulse editor

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