12 March 2004
Primary care trusts are redesigning services to improve access to local NHS treatment, but implementation is patchy and is being hampered by a lack of management capacity, the Audit Commission said this week.
Two reports from the commission examined progress on implementing a primary care-led NHS – where services traditionally provided in hospitals are offered in GP surgeries or community hospitals.
It found that PCTs were slashing waiting times by developing services provided by GPs or other clinicians with special interests, for example in diabetes and orthopaedics. Such redesigned services reduced waiting times to between one and four weeks, from 17 to 26 weeks.
But, although four out of five PCTs had redesigned at least one specialism, just 17% had redesigned five or more.
Lack of management capacity was seen as a particular problem. Andy McKeon, the commission's managing director for health, said: 'PCTs that had some stability in senior management positions tended to perform better.'
The commission was particularly concerned about management capacity in finance. He added: 'The consequences of the lack of financial management capacity are twofold. One is that they may not be spending money as efficiently as they would wish; the other is that they may not be taking decisions based on knowing the cost benefit.'
The commission also found that some practices have up to twice as much to spend on their patients as others. Dr Gill Morgan, NHS Confederation chief executive, said: 'We recognise the Audit Commission's concerns on variation in provision, but tackling this is one of a very large number of issues that PCTs are being asked to deal with simultaneously.'
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