One former DoH adviser warned that the hard-line approach could accelerate the transfer of some PCT commissioning functions to private firms.
South Central SHA chief executive Mark Britnell said trusts would be given 18 months from the date when they became operational in October 2006 to get on track financially.
Mr Britnell described the finances at some PCTs as still ‘wobbly’. Milton Keynes PCT, in the South Central region, reported a gross deficit of almost £18 million in November 2006. More than a third of PCTs across England reported deficits for 2005/6.
‘If PCTs start to fail, after 18 months it’s right and proper that we intervene,’ Mr Britnell said.
National Association of Primary Care chief executive Dr James Kingsland, a former DoH adviser, said SHAs would consider private management if current arrangements failed. He said that practice-based commissioning was the vehicle PCTs should be using to balance the books.
‘If trusts haven’t got commissioning started it may get handed over to the private sector,’ he said.
NHS Alliance chief executive Mike Sobanja said replacing management after 18 months seemed ‘quite reasonable’, but doubted whether mergers would be legally possible.
‘It would be hard to merge them as they are statutorily established — you would need legislation to change the boundaries,’ he said.
‘But SHAs have the power to change PCT management. Since PCTs have a statutory obligation to balance the books, I think re-placing managers that fail to do so seems quite reasonable.’
Dr Kingsland said it might be possible to push through mergers without legislation. He said the reorganisation last year that cut the number of PCTs from 303 to 152 had been achieved without primary legislation.