PCT numbers halved in bid to save £250m

PCTs are to be restructured so that 70 per cent share the same boundaries as local authorities. Edward Davies investigates.

PCT numbers will be cut from 303 to 152 in the latest restructuring of primary care organisations in England.

The intention is to create economies of scale by sharing workload and to align PCTs more closely with local authorities - 70 per cent of them will now share the same boundaries.

The changes also mean many PCTs revert to the old boundaries of health authorities.

The reconfigured PCTs will be formally established in October. The DoH claims the changes will save £250 million in two years.

Population sizes covered by the new trusts vary from under 100,000 in Darlington PCT and Hartlepool PCT to over a million in Surrey PCT and Hampshire PCT. In Hampshire, seven trusts are to merge into a single organisation.

Health secretary Patricia Hewitt said the DoH had listened to local concerns.

She emphasised there was no blueprint being imposed on trusts.

'The new PCTs will be better organised to commission services that suit the needs of their local population. These changes will also put more power into the hands of GPs and other front-line NHS staff,' she said.

The changes have received a mixed welcome.

Many LMCs believe the changes will cut bureaucracy by reducing the number of trusts they negotiate with (see boxes).

However, GPC chairman Dr Hamish Meldrum said that their merits could only be judged on a local basis. He criticised the costs involved and said that he doubted they would make any real difference to the cost-efficiency of the NHS.

'It seems that for many governments the answer to their problems is another structural reorganisation,' he said.

'Structural reorganisations rarely change the underlying problems. This is at best a distraction and at worst a risk of scarce resources.'

The BMA's policy department has been commissioned to look at the cost of the changes.

Dr Meldrum said that costs would not just be incurred over premises changes and equipment for new trusts but 'difficult-to-quantify areas such as stultification of work' while the changeover happens.

NHS Alliance chairman Dr Michael Dixon warned that development of practice-based commissioning could lose momentum and PCTs could lose clinical engagement while the changes take place.



Background: There are five existing city centre PCTs in Leeds, some with budget problems and others with a good surplus.

Leeds North West PCT had a £1 million surplus, while Leeds North East had an equally large deficit.

GPs hoped for a return to a single city-wide trust as existed under the health authority system.

Result: The DoH has opted for one city-wide PCT.

Leeds LMC secretary Dr Richard Vautrey (pictured) said: 'At last we are going back to the old local health authority system. It has been difficult to make decisions across five PCTs, negotiating with five different bodies.

I don't doubt this will present other challenges, but there will be a much better flow of resources across the city as a result.'


Background: Five PCTs with varying historic deficits were expected to merge into county-wide PCTs, against GPs' wishes, leaving funding and enhanced service inequities (GP, 14 April) across the patch.

Result: While most of the surrounding PCTs in south west England have merged into county-wide PCTs, such as Devon, Somerset, Wiltshire and Gloucestershire PCTs, in Avon the five PCTs have become four with only the two Bristol city PCTs merging.

Avon LMC chief executive Steve Mercer (pictured) said: 'We were gobsmacked.

On the whole this is what practices wanted. Most wanted South Gloucestershire and Bath to remain separate and 99.9 per cent support a merger between the two Bristol trusts.

'The only concern is North Somerset where deficits are very large and I fear it may mean more reorganisation in two or three years' time.'


West and East Sussex have now largely taken on all the surrounding PCTs with the exception of Brighton and Hastings.

In Hastings, Labour MP Michael Foster campaigned against SHA plans to merge all East Sussex PCTs into one. The DoH eventually decided to create a separate Hastings and Rother PCT.

In Hampshire, seven PCTs have been merged to form a county-wide Hampshire PCT. Southampton, Portsmouth and the Isle of Wight remain independent.

Dr Stephen McKenning, chairman of the Isle of Wight, Portsmouth and South East Hampshire LMC, said: 'It should be easier. The office will still be doing the same amount of work, but now we will only have to deal with four PCTs instead of 10.' The three existing Cornish PCTs have merged into a single trust for the whole of Cornwall and the Isles of Scilly.

Rosalind Winter, general manager of Cornwall and the Isles of Scilly LMC, said: 'It's good news. We've simply gone back to the old health authority boundaries. I'll never understand why they changed them in the first place.'

Buckinghamshire and Oxfordshire have formed two county-wide PCTs, while neighbouring Berkshire is divided into East and West PCTs.

Dr Paul Roblin, chief executive of Thames Valley LMCs, said: 'I currently have to deal with 13 PCTs. This will drop to five. The PCTs are already working together so it won't make much difference to us.'

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