PCTs are supposed to disappear off the NHS map in 2013 – but will they really be dismantled or simply morph into another form? Alisdair Stirling reports
Last summer, it all seemed so clear. The timetable for NHS reform published alongside the health white paper said PCTs would be abolished in April 2013 when GP consortia assumed their statutory responsibilities.
Observers, including GPs, puzzled over the question of how a PCT could hand over the reins to GP commissioners while simultaneously doing away with itself like a cartoon genie disappearing back into its bottle. Now we know the answer. They might not be going after all. At least, not by 2013.
An extra item crept into the timetable for reform at the end of January that had not been listed in the white paper documents – the formation of PCT clusters. SHAs have been tasked with establishing these by June 2011 because it has dawned on the Department of Health that ‘it will not be possible to retain effective management capacity in all PCTs until their abolition in 2013, presenting unacceptable risks to quality and financial management’.
The idea is that by consolidating management capacity, with single teams each managing a cluster of PCTs, they can make a more graceful, and gradual, exit. But as the clusters begin to carve out their role, who will take over these functions after 2013?
Senior NHS sources are understood to have speculated that as many as 50 clusters could survive the 2013 PCT abolition date, prompting speculation that all they will need is a name change – perhaps to ‘Commissioning Support Units’ – to survive.
Empire strikes back
Professor John Ashton, chair of the UK Public Health Association and director of public health at NHS Cumbria, believes clusters will remain at the behest of the DH.
He told Practical Commissioning: ‘It’s a case of the empire strikes back. The DH is instinctively centrist and NHS chief executive Sir David Nicholson has come in with the centrist proposal of clusters because there’s a huge risk in dismantling PCTs before the GP consortia are ready to take on their tasks.’
Professor Ashton says health secretary Andrew Lansley’s original proposal was to have the NHS Commissioning Board and 400 consortia and ‘nothing in between’.
‘That’s now changed. You’ll have the board, then possibly sub-national outposts of the board, clusters, consortia and beneath them, health and wellbeing boards.’
Another alternative future for PCT clusters is to eventually become sub-regional outposts of the NHS Commissioning Board, with speculation that these would number between 10 and 30.
Dr Donal Hynes, a GP in Bridgwater, Somerset, and national co-vice chair for the NHS Alliance, says GP consortia will play a part in determining which role the clusters continue to have.
‘The commissioning support role could be accomplished by many sources, including the private sector, and consortia will effectively decide who they farm that out to. But there will still be a need for locally focused contracting work that some consortia might not want to take on. That is currently done by PCTs. So sub-regional outposts of the NHS Commissioning Board could be needed to fulfil that role.’
Dr Amit Bhargava, chair of the North West Sussex Association of Commissioning Consortia, says there is a real chance that the clusters could be here to stay: ‘There are certain GP consortia that won’t be in a position to take control of the money in two years’ time. Overall, there has to be something to hold it together. It would be wrong to maintain PCTs where they aren’t needed. It’s up to GP commissioners to show they are capable and can do the job without PCT support.’
Alisdair Stirling is a freelance journalist
After PCTs – the new commissioning pyramid
NHS Commissioning Board
This will be headed by Sir David Nicholson, with an annual mandate to deliver from the health secretary
50 PCT clusters, possibly to be called commissioning support units in the transition. In the long term it is understood there could be as many as 30 regional branches of the NHS Commissioning Board. This poses the question – will these clusters morph into regional commissioning boards?
The information coming through from pathfinders is that many are federating with other consortia to make big commissioning purchases and create economies of scale in back-office functions. The federations can be as small as just two consortia.
The average consortium size in the pathfinders so far is 190,000 members. Nationally this would result in 270 consortia, though a number are expected to merge during the transition period.