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Commissioning dilemma: Being blamed for cuts

You are invited to serve on a new PCT sub-committee as an interim measure before GPs take on commissioning duties, but are worried you may be blamed for unpopular cuts you don't have the power to overturn. Ray Tarling advises on how to protect yourself.

GPs on a PCT committee will be involved in decisions that they, their practices and future consortia will ultimately have to live with. They must therefore ensure that their voices are strong and heard, and their influence is meaningful. On the other hand, the PCT (as long as it exists) will be the statutory body accountable for the decisions made. It must be the case that the PCT's directors, and not the GPs, will be held individually and collectively to account. It will be essential to agree terms of reference for the PCT committee which make those respective responsibilities and functions clear. There remains a risk that by participating in discussions, GPs may inadvertently acquire some legal responsibility for the decisions taken by the committee (as anyone regularly participating in a Board meeting may acquire the same legal liability as the Board's own directors), and PCTs should grant them a formal indemnity, backed up by the PCT's insurance with the NHSLA. The other aspect of accountability is that of reporting to the community served and those who represent them. GPs will want to be part of the process of increasing public engagement and involvement, even before consortia are formally constituted. But here, again, it must be made clear at all times that, so long as the PCT exists, it is accountable to the community for its decisions and actions.

Ray Tarling is a senior adviser in Beachcroft's Health Advisory Service

Ray Tarling

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