Chris Lancelot: An example of good PCT management

Regular readers might well think I have something against NHS managers. It is not true: I appreciate good administration wherever it occurs.

Unfortunately, high-quality management is a rare commodity in the NHS. This is a shame, because behind every bad management decision lie wasted opportunities, harder work for practitioners and fewer benefits for patients. This makes me angry, because it needn't be like this.

So it gives me great pleasure to be able to write about some exceptionally good management decisions made by one PCT which I am sure will lead to benefits for GPs, the PCT and patients alike.

It all revolves around Choose and Book, that appallingly bad implementation of the potentially good idea of online booking. To raise the numbers of electronically booked appointments, a PCT in Bedfordshire has instituted a local enhanced service (LES) unlike any I have met - it works on trust.

At the outset, practices will promise to use Choose and Book as much as they can; at the end of the year they will sign to say that they have tried their best to fulfil their obligations. That is all the reporting they have to do: the PCT is trusting practices to behave honourably in making these declarations.

In turn, practices know that the PCT holds them in high regard and will reward them fairly under the LES without adding further administrative burdens.

In this scenario, everyone wins. Practices get paid for the extra effort needed to implement Choose and Book, without increasing their administration costs; the PCT hits its targets for online booking; and the patients reap the benefits of the Choose and Book system.

But I am sure that the ultimate winner will be the future relationship between the PCT and its constituent practices. The sympathetic, honourable and understanding approach of PCT managers will lead to a sea change in the link between GPs and PCTs.

We hear so often of poor-quality NHS managers treating responsible and loyal GPs as though they were the enemy, so it is a real pleasure to be able to report this ground-breaking, high-trust enterprise. I just hope that other PCTs will learn from this novel approach and imitate it in their own patches.

Dr Lancelot is a GP from Lancashire. Email him at

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