Published Work

Future directions for primary care trusts.

Public Deposited
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  • London : King's Fund
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  • 2003
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  • 14p.
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  • Primary care trusts (PCTs) are struggling to deliver the demanding modernisation agenda set for them by ministers. In consequence, two new policy themes - stronger market incentives and the decentralisation of budgetary power - have been introduced to strengthen the commissioning role of PCTs. This discussion paper looks at how PCTs could adapt to the new policies and considers some alternative futures for them. The goal is a National Health Service where providers are more responsive to patients, and where market excesses are curbed through better regulation and new models of social ownership. We discuss potential problems arising from the government's proposals: these include inconsistencies in the approach to elective and non-elective care and concerns about whether PCTs can sustain 'virtual integration' in a competitive market place. The skewed nature of the policy on foundation trusts could impair the influence of PCTs. Further experiment may be needed to determine the best direction of travel. Suggestions include the testing of foundation 'whole systems' that include PCTs as well as foundation primary and integrated care teams. We offer three different scenarios for debate. The first ('the consumer is sovereign') maximises the use of competition within new structures of social ownership. The second ('equity first') emphasises integration, and makes little use of competition outside elective care. The third ('an ethical market') proposes that market incentives should be used only where they are consistent with the wider social mission of the PCT. The various elements of these scenarios are not mutually exclusive. They may help to create a distinctive form of managed care in the UK. [Summary]
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