19 May 2006
Newly merged NHS primary care trusts could be pushed into partnerships with large for-profit organisations, a leading community health specialist has told Public Finance.
England's 303 PCTs will be merged into 152 from October 1, the new minister for health delivery and quality, Andy Burnham, announced in the Commons on May 12. But the new trusts will start life with a cumulative inherited deficit of more than £246m.
David Janner-Klausner, head of the Democratic Health Network think-tank, told PF that deficits would not be the only problem faced by the new PCTs. Those now covering populations well above the average 300,000 would be tempted to gain economies of scale by outsourcing their provider functions to large for-profit companies.
'Is a large PCT covering population sizes of over 700,000, for example, going to be prepared to nurture small social enterprises, as the DoH has suggested? The easy win for them will be a multinational – as with United Healthcare Europe in Derbyshire,' he said.
Burnham said the changes would benefit both patients and taxpayers as 'fewer, more strategic PCTs will be better placed to ensure effective commissioning of services for patients'.
He added that £250m worth of the savings would be released through the merging of 'back-office' functions – the equivalent of 50,000 heart operations.
Speaking to PF after the announcement, health reform minister Lord Warner confirmed that the new PCTs would inherit the deficits – as well as surpluses – of their predecessors.
'We don't wipe the slate clean,' he said. 'There's no Father Christmas here with another crock of gold. The merger doesn't change what is inherited.'
PCT deficits are forecast in 19 out of the 24 strategic health authorities. In four SHAs — Shropshire & Staffordshire, Bedfordshire & Hertfordshire, Hampshire & the Isle of Wight and Avon, Gloucestershire & Wiltshire – PCTs have deficits of more than £20m.
The five new PCTs under the Norfolk, Suffolk & Cambridgeshire SHA will each inherit a part of the region's £67.7m primary care deficit.
New PCTs in Leeds, Derbyshire County, Norfolk, Eastern & Coastal Kent and West Sussex will cover population sizes of more than 700,000.
Berkshire East and Surrey will each cover more than 1 million patients. Under the old configurations, the populations covered were between 100,000 and 300,000.
Burnham reiterated Health Secretary Patricia Hewitt's earlier pledge that PCTs would not be forced to outsource provider functions 'unless and until' they decided otherwise.
PFmay2006
