Primary care trusts, the first of which began work two years ago
and which now control 75 per cent of the NHS budget, are the
government’s designated method of transforming the way health and
social care are delivered in our communities.
So what is the prognosis for PCTs as they seek to reconfigure the
machinery of care? As usual it depends where you look. The success
stories are more likely to be found where room has been made for
leadership and imagination, a commitment to work in partnership and
a willingness to do things differently. The horror stories, by
contrast, are usually found where the ability or will to rethink
patterns of provision is lacking.
Under the new GP contract, doctors are to be rewarded for providing
enhanced services to a range of vulnerable groups including
substance misusers, asylum seekers and homeless people. Therefore
it is particularly disappointing that many PCTs, particularly in
inner cities where the problems are worst, continue to channel
money to hospitals at the expense of these schemes to support
people from disadvantaged backgrounds.
It is hard to see how this attitude will help PCTs fulfil their
overriding objectives to reduce health inequalities and foster the
social and economic regeneration of their communities through
Here and there, though, the ice has begun to break. There are three
examples in this week’s issue: the primary care liaison nurse who
runs a project focused on the health needs of people with learning
difficulties; the GPs who have set up a city-wide scheme to support
asylum seekers; and the team set up by a PCT to attend to the
social and emotional problems of isolated and vulnerable
For parts of the health service, the renewed emphasis on prevention
may seem as alien as it is hard to implement. But the concept is
more familiar in social care, where professionals should be
heartened by the changes under way in primary health care.
It is a chance for social care to make its presence felt.