The West Midlands is divided into three Strategic Health Authorities (SHAs): Birmingham and The Black Country SHA (10 PCTs), Coventry, Warwickshire, Herefordshire and Worcestershire SHA (8 PCTs) and Shropshire and Staffordshire SHA (10 PCTs).
PCTs generally have non-executive Boards comprising local people appointed by the Secretary of State for Health, a chief executive, director of finance, director of public health and possibly others, e.g. doctors, nurses and members of other caring professions. Many have an Executive Committee consisting of health professionals, and staff from local authority social services. They are supported by managerial and administrative teams. In some areas, these support teams are shared by two or more PCTs.
In Dudley there are currently two PCTs serving the north and south of the Borough – Dudley Beacon & Castle PCT and Dudley South PCT.
Organisational Purpose
Primary Care Trusts (PCTs) are local statutory organisations involving all general practitioners (GPs), dentists, pharmacists, opticians, community nurses and allied health professionals in a specific geographical area with a population of around 150,000. They are responsible for securing and providing health services to their population, including prison populations and patients who live outside the area but who registered with GPs covered by the PCT.
PCTs work in partnership with local authority social services and other agencies to plan, fund and deliver services to meet all the local community’s health needs, ensuring they are accessible for all. They are also responsible for ensuring local health and social care systems work together to the benefit of patients.
PCTs are responsible for allocating around 75% of the NHS budget. They are able to fund hospital and community services in addition to providing some services themselves, e.g. Community Nursing, Family Planning and Occupational Therapy. They have scope to pool resources with local authorities in order to improve services.
The National and Regional Picture
England is covered by 28 Strategic Health Authorities (SHAs) which were set up in 2002 with responsibility for developing plans for improving health services in their local area, making sure their local NHS organisations were performing well, increasing the capacity of local health services, and ensuring national priorities, e.g. improving cancer services, are integrated into local health service plans. Within each SHA, the NHS is split into various types of Trusts that take responsibility for running the different NHS services in the local area: Acute Trusts, Ambulance Trusts, Care Trusts, Mental Health Trusts and PCTs. There are 304 PCTs in England.
Common Purpose with LSPs
PCTs are local organisations, created to work with partners to deliver improvement by being responsive to local needs as expressed by local people. However, PCTs have a more direct interest in service delivery than LSPs do through their statutory responsibilities for commissioning secondary care services and the majority of hospital services.
PCTs work towards meeting the NHS targets to improve health outcomes for local populations and help people safeguard or improve their health contributes directly to wider LSP outcomes. The NHS has a long history of evidence-based working and PCTs have or can access a wide range of relevant data relating to LSP Floor Targets, neighbourhood needs and service provision.
Drivers
The Healthcare Commission, which promotes improvement in the quality of the NHS and independent healthcare, has a statutory duty to assess the performance of PCTs and award annual performance ratings. They look at a broad range of issues, checking PCT self-assessments by analysing information on performance and by talking to partners and observers. A particular emphasis is placed on what is being done to reduce inequalities in access to health care and in the health of the population. In some areas gaps are widening. For 2005/6, the Commission’s Chief Executive has said, “healthcare organisations will have to demonstrate to us that working with others, including local government, they have assessed the different needs and inequalities within the local population and explain how services and resources are deployed to address them”. They are also concerned to ensure that the PCT’s approach is based on good information, use of evidence and the capacity to deliver effective services and programmes that reflect local needs.
Benefits and Constraints from LSP Engagement
Benefits
A key driver for the NHS is not only to treat the unwell but to promote better health amongst the whole population. However, factors outside the control of the NHS do have a significant impact on the health and well-being of the population that the PCT serves.
Working as part of the LSP the PCT can help direct wider policy – such as housing and education – to ensure that developments have a positive impact on the health and wellbeing of the population.
The PCTs can also help to develop a higher local profile for health issues – ensuring that the responsibility for providing the conditions and support necessary for a healthier population are shared by all.
In Dudley, the PCT works closely with Social Services to ensure that care is provided at the right time, in the right way and in the right place to those who need it – a partnership that has proved invaluable to providing better care in the borough.
In addition, working as part of the Health and Wellbeing Partnership, the wider issue of health inequalities in Dudley is now being tackled with a partnership forum, where the responsibility for issues such as smoking cessation and teenage pregnancy are shared in a multi-agency approach.
Overall, the benefit for Dudley’s PCT’s as part of the Local Strategic Partnership is to improve the way we deliver care, to provide more personalised support to people in the Borough who need it and to build upon a strong record of service delivery.
Constraints
NHS requirements on PCTs that “appropriate consent is obtained … for use of any confidential patient information” and “staff treat patient information confidentially, except where authorised by legislation to the contrary”, means that even within the NHS there can be problems sharing data. Some LSPs have found it difficult to obtain data from their PCT. PCTs and their LSP partners may need to work up protocols on data sharing to manage concerns.
While local health services must be involved with PCTs as a statutory requirement, it is no more than an ‘expectation’ that they should be interested and involved in the work of LSPs. Under pressure of time and other resources, it is likely that for many health professionals PCT-related work would take precedence over their work with the LSP.
For commercial reasons, some GPs are unwilling to disclose details of the general health of their patient populations.
Relationship with other Partnerships
- Crime and Disorder Reduction Partnerships
- Drugs and Alcohol Action Teams
- Excellence in Cities Clusters
- Children and Young People’s Strategic Partnerships
- Local Compacts
More Information
Other things you need to know
The boundaries of PCTs and LSPs do not necessarily coincide, and an LSP may need to work with more than one PCT - which may have different priorities, attitudes to data-sharing, etc.
PCTs work very closely with the Fire and Rescue Service and with the Ambulance Service. Increasingly they are working with Jobcentre Plus on employment and health-related initiatives, e.g. in support of Incapacity Benefit claimants.
Find out more
PCTs - www.nhs.uk
Care Quality Commission - www.cqc.org.uk
Primary Care Commissioning - www.pcc.nhs.uk
NHS Networks: website designed to connect leaders and innovators across the NHS with each other and with otherswww.networks.nhs.uk/
