Among them were 1,122 GPs, 900 of them principals, many with detailed accounts of their PCT's efforts to commission and manage excellent and improving primary care.
A principal from Wandsworth, in south west London, said: ‘The LMC has worked hard to ensure relationships with the PCT are good. This has really improved and there is a real commitment made by the PCT to engage in dialogue which is relevant and timely in the main with the LMC, bimonthly Standing Joint Liaison Committee and bimonthly steering group. The dialogue feels open and helpful, of a non-combative nature, willing to listen. Unfortunately high-level decisions sometimes cut across the work that is being done in these committees.
‘The functionality of the PCT on a day-to-day basis is limited because of the reasons stated below regarding the team structures.
‘Having said that, it is aware of the GPs' concerns and have endeavoured to facilitate communication as best it can. The PCT has engaged with the enhanced appraisal agenda by appointing a local GP as the appraisal lead and this in turn has led to very useful regular local appraiser meetings. Education for primary care has not really featured in the same way, especially compared with all the activities that took place in PCG and early PCT days.
‘The PCT has been supportive of the PBC process although the realisation of the potential PBC has to offer has been limited.
‘The PCT has supported the creation of federations of GPs across the patch financially. The PCT has gone out to the local health community and the public to look at health needs versus health care provision in areas of deprivation and developed plans to accommodate the findings. Unfortunately, the financial package awaiting us in 2010 and onwards is limiting the realisation of these plans significantly.
‘The PCT has used the local enhanced service process across a very wide range of activities and this in turn has increased the enhanced activities that are now practice based. There is increasing concern about what will happen to these innovations when the financial stringencies bite hard over the next year and onwards.
‘The PCT has supported practices over the last 18 months by engaging in a redecoration programme to ensure that premises are up to standard as best as possible, taking into account infection control and health and safety.'
A partner from Greenwich PCT, south east London, said: ‘I believe the directors of primary care and commissioning departments are very capable and forward thinking. They are also keen to listen and take views on board, they are keen to build transparent and good relations and eager to learn from the practices.
'The assistant directors however are not as good, they are not efficient or fair and do their bosses a disservice. It feels as if progressive practices are being penalised.'
A practice in South Staffordshire said: ‘The chief exec at South Staffs PCT has been incredibly supportive in developing PBC. He has developed a culture that puts PBC at the heart of the organisation.'
‘The culture developed by the chief exec has enabled PBC to develop to a point where PBC consortia are actively involved in service re-design. Monthly meetings with the PBC chairs and chief exec enable PBC to be part of the decision making process of the PCT.'
A principal in Tower Hamlets, east London, said: ‘It is clear that the PCT wants to improve the standard of practice in Tower Hamlets.
We get excellent support from the PCT pharmacist and our local enhanced services are led by designated teams who visit regularly.'
A principal from Sheffield said: ‘The managers and public health staff I directly deal with are excellent and their knowledge and motivation is of high quality and they produce data at my request and we are working together on a training package and a local incentive scheme.'
One principal from Sheffield said: ‘The quality of staff is very variable. There are (a few) excellent people in the organisation, but most seem to regard general practice as a problem to be dealt with rather than a resource to be supported.'
Another said: ‘Good practice is the willingness to share our own data which they have collated, with us as practices. I am working constructively with managers on getting this data and presenting it in a user-friendly version with support, to practices. Knowing how you're doing is the way to improve practice and our PCT are very helpful in this.'
A sessional GP from Sheffield said: ‘I am very well supported as a GP appraiser by the admin and educational team. I am a QOF and information management and technology assessor and have been included positively in the discussions about how these assessments might be conducted.'
Not everyone is supportive. A GP from Oxfordshire said: ‘Well, I could have been incredibly disparaging. We get a PCT that is doing its job, but the job it has to deliver is one that is unconstructive and therefore although it is doing its job well, it is not helpful. The PCT like all PCTs I assume is a perfect example of Parkinson's Law. We have for example one 'manager' whose job has been for the last five years to reconfigure the diabetic service. I sense a couple of GPs could sort it in a matter of weeks, yet he is still employed. We have a PBC consortium of eight practices with a service development manager who looks after two small consortia, ours and one other. Underneath him he has two assistants. What the hell do these people do all day? I recall when we had a Family Practitioner committee with 12 people on the list, we now have a PCT with 1,200 staff. Surely we ought to merge all these PCTs and leave things up to SHAs?
'Where is the evidence that spending all this money on management delivers results? Auditing primary care in a micromanagement way surely is not value for money. How many times do they pick up issues that show a lack of probity etc? This is clearly a rant, but primary care is lean, PCTs are not.'
A Mid Essex practice said: ‘The PCT always seems under staffed. The staff it does have change constantly. My impression is on the whole the staff try and do their best but do not understand what happens in primary care. Decisions are taken that affect us, but without including us in the process. We are constantly being asked to do work that isn't relevant to patient care, eg survey review of GP premises.'
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