NHS primary care trust

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A primary care trust could commission community health centres. Jericho Health Centre 20050326.jpg
A primary care trust could commission community health centres.

Primary care trusts (PCTs) were part of the National Health Service in England from 2001 to 2013. PCTs were largely administrative bodies, responsible for commissioning primary, community and secondary health services from providers. Until 31 May 2011, they also provided community health services directly. Collectively PCTs were responsible for spending around 80 per cent of the total NHS budget. Primary care trusts were abolished on 31 March 2013 as part of the Health and Social Care Act 2012, with their work taken over by clinical commissioning groups.

Contents

Establishment

In 1997 the incoming Labour Government abolished GP Fundholding. In April 1999 they established 481 primary care groups in England "thereby universalising fundholding while repudiating the concept." [1] Primary and community health services were brought together in a single Primary Care Group controlling a unified budget for delivering health care to and improving the health of communities of about 100,000 people. A PCG was legally speaking a subcommittee of a district health authority. As part of the implementation of the NHS Plan 2000 PCGs were transformed into primary care trusts. 17 trusts were established in April 2000, a further 23 in October 2000, and 124 in April 2001 with a plan that all primary care groups would become trusts by 2004. This was said to be a break with the market culture of the previous government, replacing GP Fundholding with a corporate culture that emphasises partnership and collective responsibility. [2]

PCTs held their own budgets and set their own priorities, within the overriding priorities and budgets set by the relevant strategic health authority, and the Department of Health. They provided funding for general practitioners and medical prescriptions; they also commissioned hospital and mental health services from NHS provider trusts or from the private sector. Many PCTs used the naming style of "NHS" followed by the geographical area, to make it easier for local people to understand the management of the NHS locally.

Management

PCTs were managed by a team of executive directors headed by a chief executive. These directors were members of the trust's board, together with non-executive directors appointed after open advertisement. The chairman of each trust was a non-executive director. Other board members included the chair of the trust's professional executive committee (PEC) (elected from local general practitioners, community nurses, pharmacists, dentists etc.).

The financial budgets, and much of the agenda, of PCTs were effectively determined by directives from the strategic health authority (SHA) or the Department of Health.

Restructuring

In 2005 the government announced that the number of strategic health authorities and primary care trusts would be reduced, the latter by about 50 per cent. The result was that, as of 1 October 2006, there were 152 PCTs (reduced from 303) in England, with an average population of just under 330,000 per trust. After these changes, about 70 per cent of PCTs were coterminous with local authorities having social service responsibilities, which facilitated joint planning. [3]

Providing responsibilities were gradually removed from PCTs under the Transforming Community Services initiative.

On 12 July 2010, Andrew Lansley unveiled a new health white paper (which eventually became law as the Health and Social Care Act 2012 [4] ) describing significant structural changes to the NHS under the Conservative and Liberal Democrat coalition government. Among the changes announced, PCTs were to be abolished by 2013 with new GP-led commissioning consortia, clinical commissioning groups, taking on the responsibilities they formerly held. [5] The public health aspects of PCT business would become the responsibility of local councils. Facilities owned by PCTs would transfer to NHS Property Services. Strategic health authorities would also be abolished under these plans. Following widespread criticism of the plans, on 4 April 2011, the Government announced a "pause" in the progress of the Health and Social Care Bill to allow the government to "listen, reflect and improve" the proposals. [6]

The Health and Social Care Act 2012 received royal assent on 27 March 2012 [4] and PCTs were formally abolished on 31 March 2013. Some of their staff were transferred to commissioning support units, some to local authorities, some to clinical commissioning groups, some to NHS England and some were made redundant.

See also

Related Research Articles

<span class="mw-page-title-main">Department of Health and Social Care</span> Ministerial department of the UK Government

The Department of Health and Social Care (DHSC) is a department of His Majesty's Government responsible for government policy on health and adult social care matters in England, along with a few elements of the same matters which are not otherwise devolved to the Scottish Government, Welsh Government or Northern Ireland Executive. It oversees the English National Health Service (NHS). The department is led by the secretary of state for health and social care with three ministers of state and three parliamentary under-secretaries of state.

An NHS trust is an organisational unit within the National Health Services of England and Wales, generally serving either a geographical area or a specialised function. In any particular location there may be several trusts involved in the different aspects of providing healthcare to the local population. As of April 2020 there were altogether 217 trusts, and they employ around 800,000 of the NHS's 1.2 million staff.

Strategic health authorities (SHA) were part of the structure of the National Health Service in England between 2002 and 2013. Each SHA was responsible for managing performance, enacting directives and implementing health policy as required by the Department of Health at a regional level.

NHS West Essex was a NHS primary care trust (PCT) in Essex, England. Formed in October 2006 following the merger of the three previous primary care trusts – Epping Forest, Harlow and Uttlesford, it has an annual budget of £370m. It covers approximately 390 square miles (1,000 km2), from Buckhurst Hill to Steeple Bumpstead with a population of about 280,000. It is responsible for improving primary care and the health of the local population and with a statutory responsibility for providing health services.

<span class="mw-page-title-main">Health and Social Care Act 2012</span> United Kingdom legislation

The Health and Social Care Act 2012 is an act of the Parliament of the United Kingdom. It provided for the most extensive reorganisation of the structure of the National Health Service in England to date. It removed responsibility for the health of citizens from the Secretary of State for Health, which the post had carried since the inception of the NHS in 1948. It abolished primary care trusts (PCTs) and strategic health authorities (SHAs) and transferred between £60 billion and £80 billion of "commissioning", or healthcare funds, from the abolished PCTs to several hundred clinical commissioning groups, partly run by the general practitioners (GPs) in England. A new executive agency of the Department of Health, Public Health England, was established under the act on 1 April 2013.

<span class="mw-page-title-main">Clinical commissioning group</span>

Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integrated care systems as a result of the Health and Care Act 2022.

Healthcare in Devon was the responsibility of two clinical commissioning groups until July 2022, one covering Northern, Eastern and Western Devon, and one covering South Devon and Torbay. It was announced in November 2018 that the two were to merge.

Healthcare in Worcestershire was the responsibility of three Clinical Commissioning Groups until July 2022, covering, respectively Redditch and Bromsgrove, Wyre Forest and South Worcestershire.

Healthcare in Somerset, England was the responsibility of three clinical commissioning groups (CCGs) until July 2022. These covered the ceremonial county of Somerset, which comprises the areas governed by the three unitary authorities of Somerset, North Somerset and Bath and North East Somerset.

Healthcare in Sussex was the responsibility of seven Clinical Commissioning Groups covering: Brighton and Hove; Coastal West Sussex; Horsham and Mid Sussex; Crawley; Eastbourne Hailsham and Seaford; Hastings and Rother; High Weald; and Lewes-Havens from 2013 to 2020. From April 2020 they were merged into three covering East Sussex, West Sussex, and Brighton and Hove.

Healthcare in Cornwall was until July 2022 the responsibility of Kernow clinical commissioning group, a National Health Service (NHS) organisation set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in England. As far as the NHS is concerned, Cornwall includes the Isles of Scilly.

The "Greater Manchester Model" of NHS health care was a system uniquely devolved within England, by way of close integration with the Greater Manchester Combined Authority and local authorities, led by the Mayor of Greater Manchester. In July 2022 the Greater Manchester integrated care system took over responsibility for health and social care in the conurbation. The financial plan for 2022–23 had an initial shortage of £187 million.

Healthcare in the West Midlands was, until July 2022, the responsibility of five clinical commissioning groups: Birmingham and Solihull, Sandwell and West Birmingham, Dudley, Wolverhampton, and Walsall.

Healthcare in Surrey was the responsibility of five Clinical Commissioning Groups: East Surrey, North West Surrey, Surrey Downs, Guildford and Waverley, and Surrey Heath from 2013 to 2020 when East Surrey, North West Surrey, Surrey Downs, Guildford and Waverley merged to form Surrey Heartlands CCG. The new organisation started with a £62 million deficit.

Healthcare in Gloucestershire was the responsibility of two clinical commissioning groups, covering Gloucestershire and South Gloucestershire, until July 2022. The health economy of Gloucestershire has always been linked with that of Bristol.

Healthcare in Leicestershire was the responsibility of three clinical commissioning groups covering West Leicestershire, Leicester City and East Leicestershire and Rutland until July 2022. As far as the NHS is concerned Rutland is generally treated as part of Leicestershire.

Healthcare in Northamptonshire was the responsibility of Northamptonshire Clinical Commissioning Group until July 2022, with some involvement of Cambridgeshire and Peterborough CCG.

The NHS internal market was established by the National Health Service and Community Care Act 1990, to separate the roles of purchasers and providers within the National Health Service in the United Kingdom. Previously, healthcare was provided by regional health authorities which were given a budget to run hospitals and community health services in their area. The Health and Social Care Act 2012 was intended to open up the internal market to external competition. The 2019 NHS Long Term Plan called for the establishment of integrated care systems across England by 2021, effectively ending the internal market.

<span class="mw-page-title-main">Healthcare in Durham</span> Healthcare services

Healthcare in Durham, from 2013 to July 2022, was the responsibility of NHS Durham Dales, Easington and Sedgefield, and Sunderland and South Tyneside clinical commissioning groups. In July 2019 they proposed to merge into two, one covering Durham, and the other covering Tees Valley and including Darlington.

References

  1. ↑ Klein, Rudolf (27 November 1999). "Markets, politicians, and the NHS". British Medical Journal. 319 (7222): 1383–4. doi:10.1136/bmj.319.7222.1383. PMC   1117121 . PMID   10574834.
  2. ↑ Wilkin, David; Gillam, Steve; Smith, Keri (16 June 2001). "Tackling organisational change in the new NHS". British Medical Journal. 322 (7300): 1464–1467. doi:10.1136/bmj.322.7300.1464. PMC   32310 . PMID   11408304.
  3. ↑ "Local health bodies face shake-up". BBC News. 16 May 2006. Retrieved 6 July 2014.
  4. 1 2 "Health and Social Care Act 2012". UK Parliament Website. Retrieved 4 April 2013.
  5. ↑ Ramesh, Randeep (12 July 2010). "Pro-market agenda drives NHS reforms". The Guardian . Guardian Media Group . Retrieved 30 March 2015.
  6. ↑ Mulholland, Hélène (6 April 2011). "Government to 'pause, listen, reflect and improve' NHS reform plans". The Guardian. Guardian Media Group. Retrieved 6 April 2011.
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