In March 2006, the government responded to the Health Committee’s critical report on its proposed reforms to primary care trusts (PCTs). The paper explained that the government’s reform plan had four strands running through it, namely:
- more choice, better information and stronger voice for patients
- a more diverse range of providers, who would have the ability and freedom to innovate and improve services
- a system where money would follow the patient, thereby creating an incentive for providers to offer high quality services to attract contracts and patients
- the development of a framework of regulation and decision making, assuring quality, equity and value for money.
The document explained that PCTs needed to commission better services, work more closely with local government counterparts and obtain better value for money. Although the government noted the committee’s concerns that PCTs should have been allowed to evolve, it felt that not all PCTs would have benefited from this approach.
The government felt that the Health Committee’s concerns about the destabilising effect of reconfiguration were unfounded and concluded that the changes were likely to have an opposite effect, noting that:
‘While restructuring can be disruptive, this is not change for change’s sake. This change is necessary to equip the NHS to deliver the next stage of the reform programme. The NHS has been telling us for some time that structural change is necessary and commissioning a patient-led NHS is a response to that – it is not a return to the old health authorities.
The government simply does not accept that these changes will set services back 18 months, or indeed at all. This reconfiguration is not a sudden change. It is part of a planned and managed programme of NHS reform aimed at delivering improved quality of care for patients and value for money for taxpayers.’
The report stated that the commissioning capacity of PCTs would be strengthened by the reforms, and patients would ultimately benefit. It further asserted that PCTs could not stay static in form and function and needed to change and adapt.
In response to the committee’s concerns around practice-based commissioning (PBC), the government argued that PBC would allow primary care professionals to reduce hospital admissions and be better equipped to manage care pathways for patients. PCTs would still have a role in supporting and managing PBC groups, by agreeing budgets with practices, negotiating and managing contracts and making sure that budgets were being spent appropriately.
The government made it clear that PCTs would still be able to provide services. Where PCTs continued to provide services they would be expected to ensure they had clear governance arrangements established to monitor any conflicts of interest between their commissioning and provider functions. The document asserted that the government would not instruct PCTs to give up their provider functions, but would support those who wished to.