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Thursday 27th October 2016

New PCTs: so what is different?

28th January 2007

11122006_the_future_of_the_nhsQ.jpg1 Establishing the new PCTs

Last October the number of PCTs in England was reduced from 303 to 152. This reconfiguration, set out in Commissioning a Patient Led NHS (CPLNHS), is the first of a series of changes designed to strengthen PCTs.

The new PCTs are responsible for 80% of the total NHS budget. The average catchment population is 330,000; the smallest PCT covers only 90,000 while the largest covers 1, 253,000. Approximately 70% of the new PCTs are coterminous with local authority boundaries.

2 Key functions of PCTs

The main functions of the PCTs remain to:

• Engage with the local population to improve health and social well being.

• Commission a comprehensive and equitable range of high quality, responsive and efficient services, within allocated resources, across all service sectors.

• Directly provide high quality responsive and efficient services, where this gives best value.

This requires PCTs to:

• Lead the local health system and deliver through effective partnerships with practice-based commissioners, Local Authorities and other suppliers.

• Hold providers to account through effective commissioning and contracting.

• Be accountable, directly to the local population, through the Oversight & Scrutiny Committee (OSC) and to the Strategic Health Authority (SHA).

3 So what is different?

The reduction in the number of PCTs has also been accompanied by a major shift in the role, accountability and performance expectations of the new organisations as set out below:

• Change of role – PCTs must be pro-active in deciding how services should best be provided to meet local health needs. It also has full discretion and control over budget allocation and activity commissioning.

• Larger organisations – PCTs are bigger and more complex. They also need to tackle the challenges associated with merger, such as disillusioned staff, conflicting strategies, different systems and working practices etc.

• Increased accountability – PCTs have greater board oversight from DH and the SHA, and higher levels of transparency and public scrutiny.

• Higher performance expectations - PCTs have well defined performance metrics and targets to deliver. This is heavily focused on financial and outcome targets, with an explicit expectation that spending will be directly linked to outcomes and value for money will be managed.

4 Why are changes being made?

These changes have been made to strengthen the PCTs and their ability to develop a more robust, expert approach to commissioning. It is anticipated that this will deliver a more patient focussed NHS and counterbalance the power of many providers in the system. Stronger PCTs are vital to delivering the changes set out in CPLNHS. In particular improved commissioning should ensure that:

• Local NHS budgets are spent as effectively as possible.

• New models of service are developed, and old ways of working challenged.

• Money is spent on areas of greatest need, rather than areas where demand is more vocal.

• Practice-based commissioning develops effectively to ensure GPs and community clinicians are able to manage patients’ care pathways and shift resources / services into the community as appropriate.

5 What is the PCT Fitness for Purpose programme?

The Department of Health has commissioned the PCT Fitness for Purpose programme to ensure that the new PCTs are organisationally robust and capable of delivering the required changes. The programme is designed to:

• Assess the current state of the new PCTs against their new expanded role.

• Identify development and capability needs.

• Establish a development plan and actions to deliver the required changes.

The establishment and implementation of a robust development plan for each PCT is vital to ensuring that the PCTs are ‘Fit for Purpose’ within 18 months.

6 What does the programme involve?

Several diagnostic tools have been developed to support the ‘Fit for Purpose’ assessment. These tools have been piloted with a number of PCTs and are now being rolled out across the new PCTs in England.

6.1 Commissioning Diagnostic Tool

This measures 4 key commissioning functions of the PCT as follows:

• Strategic planning reviews the ability to create appropriate integrated strategic plans. They should be fact-based and developed through a process of active stakeholder engagement.

• Care pathway management assesses the approach to demand management, the strengthening of care pathways and the development of practice-based commissioning.

• Provider management covers relationships with suppliers and managing the market (including the PCT’s own provision) through the use of comprehensive information, robust contracts, appropriate performance standards and the development of new providers / services.

• Monitoring and remediation examines the monitoring / review of key outcomes, including the patient experience, clinical quality, health outcomes of the population and financial dealings.
It also sets out all the activities necessary for good commissioning at PCT level, including expected standards and examples of UK / international best practice. It allows PCTs to be benchmarked against best practice commissioning.

6.2 Organisational Assessment Tool

This reviews the core competencies of the PCT (finance, strategy, quality, governance, external relations and emergency planning) and is similar to the Foundation Trust diagnostic. The tool measures PCTs against objective minimum performance goals and focuses on outcomes. The results of the assessment are aggregated into traffic light ratings for each category. This is designed to give an objective view of the PCT’s ability to meet its baseline performance goals over the next 12 months. PCTs will be given a rating of green, amber or red. Assessment ratings will be addressed in “Board to Board? presentations. PCTs with amber or red ratings will be required to develop a recovery plan, agreed with the SHA, addressing failure and mitigating/preventing future risks.

• Financial assessment requires the completion of a standardised financial template and a review of internal financial processes and controls. The findings are summarised and presented as financial risk metrics.

• Strategy assessment confirms that the PCT’s strategy is robust and covers assessment of the current situation, identification of aspirations, operational planning and plan validation.

• Quality assessment is based on the Healthcare Commission’s Annual Health Check.

• Governance assessment confirms that standards for financial governance, clinical and health governance, and the quality of patient experience have been met.

• External relations examines the organisation’s key relationships with providers, practices, local authorities, local communities, the SHA/DH, regulators and suppliers.

• Emergency planning ensures the PCT has appropriate emergency preparedness plans in place.

6.3 Achieving a Fit for Purpose PCT

Following these assessments the PCTs are required to prepare and agree:

• A development plan to address the weaknesses identified through the Commissioning Diagnostic Tool.

• An action plan to address the risks identified by the Organisational Diagnostic Tool.

Both plans are signed off with the SHA who is then responsible for performance managing the delivery of the plans by the PCT.



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