Come back PCTs – all is forgiven

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Published: Tuesday, 05 April 2011 15:12
Written by News Editor
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The Health Select Committee, chaired by former health secretary, Stephen Dorrell, has reported on commissioning in the light of the Health Bill, which has been put on hold by the Government. The committee recommends that the GP consortia should commission both primary and secondary care, including dentistry. They should however be enlarged to include other health professionals and be more accountable to the public. If this is accepted they will look very much like PCTs do now.


The local commissioning bodies proposed by the Bill will be public authorities responsible for more than half of the largest of all public service expenditures. Voters and taxpayers are entitled to expect that the legislation which establishes them reflects standards of good public sector governance.
The Committee does not agree that it would be "over-prescriptive" to require local commissioning bodies to adopt governance structures which meet basic standards of good governance. As statutory NHS bodies, spending large sums of taxpayers’ money, they should be legally required to have a governance structure (including a formal Board) which complies with minimum requirements set out by the Secretary of State in secondary legislation.
The Committee therefore recommends that the statutory governance arrangements for local commissioning bodies should prescribe that GPs should be a majority of the members of the Board, but that other places should be preserved to reflect the range of other (clinical and non-clinical) considerations which impact on effective commissioning.
The Committee also recommends that the statutory governance arrangements for local commissioning bodies should prescribe that the membership of the Board should include representatives of nurses and of secondary care doctors.
The Committee recommends that the statutory governance arrangements for local commissioning bodies should prescribe that Directors of Public Health or a public health professional nominated by them should sit on the boards of Commissioning Authorities.
The Committee finds that the evidence provided by the Secretary of State and officials runs counter to the direction of policy. If integration of primary and secondary care commissioning is important, then separating them in order to support the proposed system architecture may cause significant harm to the commissioning system as a whole, and should be reconsidered.
The Committee agrees that confidence in the governance arrangements of local commissioning bodies is key to them taking on greater responsibility for primary care commissioning. The Committee considers that arguments for the complex arrangements set out by the Government fall away if our proposals for significantly strengthened governance in NHS Commissioning Authorities are accepted. Given this, the Committee recommends that NHS Commissioning Authorities should assume responsibility for commissioning the full range of primary care—including services such as pharmacy and dentistry as well as general practice—alongside their other responsibilities.
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