Practices across England have delivered a blistering attack on the performance of their PCTs. But some regions stand out as especially poor performing, while GPs judge others to be performing relatively well.
In GP's 1,655-response Rate Your PCT survey, respondents in the North East and East Midlands SHA areas were least likely to have confidence in their PCT. Seventy-eight per cent of respondents in these regions gave their PCT a 'no confidence' vote.
Compare that with the North West SHA, which had the highest positive confidence ratings in England - albeit with only 22 per cent of respondents expressing confidence in their PCT.
Regional differences naturally conceal pockets both of resistance and support. In bottom-placed East Midlands SHA, Derbyshire County PCT scored well above the national average.
|Full results of GP’s Rate Your PCT survey by strategic health authority|
Derbyshire LMC secretary Dr John Grenville puts this down to 25 years of hard work building a good relationship with Derbyshire County and Derby City PCTs, and their predecessors.
Jackie Pendleton, NHS Derbyshire County's assistant director of commissioning for primary care, points to more recent 'positive relationships' developed 'over the past year'.
Conversely, in West Midlands SHA, where confidence was generally above average, not a single GP gave Worcestershire PCT a vote of confidence.
Dr Simon Parkinson, secretary of Worcestershire LMC, is 'not in any way surprised' by this. GP asked the PCT to comment, but it failed to respond.
The Rate Your PCT survey tapped a deep well of GP discontent, most of it specific to England. Forty-four per cent of respondents from London rated PCT staff's helpfulness and understanding of their needs as poor. A spokesman for the city's SHA pointed to opinion polls showing high patient satisfaction with the NHS in the capital.
Over half of respondents in South East Coast SHA area said PCT staff availability was poor. Fifty-seven per cent in the North East SHA said their PCT's support for their practice is poor.
Negativity may be no surprise in an anonymous survey, with self-selecting respondents. Yet it was far from all bad news.
Seven per cent of practices in the North West SHA region - more than twice the English average - said their PCT is an excellent commissioner.
Leading the way
North West SHA's PCTs led the field in England in 'excellent' ratings for financial management, 'inspiring, innovative' leadership and for support with education and training.
The SHA puts its success down to the quality of its clinical engagement and an active commissioning clinical lead and executive committee chair network. 'We place a strong emphasis on clinical engagement and shared leadership between clinicians and managers,' a spokesman said.
The worrying thing is that even in areas like Derbyshire with relatively good PCT relations, the augurs are not good.
'Things are changing. Life is getting much more difficult,' said Dr Grenville. 'PCTs are under immense pressure; being asked to do impossible things in impossible timescales. Many individuals in PCTs are consumed by anxiety for their jobs.'
Top down management
Many GPs point to a new tension between their PCT and 'top-down' DoH or SHA edicts.
GPs from Doncaster, Lewisham, Eastern and Coastal Kent, Northamptonshire, Somerset, Enfield and Wolverhampton all told variants of the same story of 'batty diktats', 'political agendas' and 'DoH lapdogs'.
We asked NHS North East and East Midlands SHAs to comment on their joint bottom placing in GP's league table.
NHS East Midlands said it was 'confident in PCT ability to effectively commission primary care and develop effective relationships with GPs'.
Richard Barker, NHS North East operations and performance director, said last year the region researched 'how communications and engagement can be improved with primary care providers.'
The SHA and its PCTs are now using the research to 'strengthen local links and make sure that national policy is communicated effectively and implemented appropriately by everyone.'
Which, from many GPs' point of view, is exactly the problem.