Care groups fail to integrate

Four out of 10 social services representatives on the boards of
primary care groups and trusts have “little or no influence”,
according to research carried out for the Department of Health.

Although the government encourages PCGs and PCTs to work in
partnership with hospitals, councils and the voluntary and private
sectors in developing and commissioning services, progress so far
is “disappointing”.

According to a joint report by the National Primary Care
Research and Development Centre and health think-tank the King’s
Fund, failings were most notable in the fields of learning
difficulties, mental health and older people’s services, where
health authorities still played a major role with social services
departments.

“The evidence of actual progress in joint commissioning
activities with social services, even in respect of priority groups
such as older people, was disappointing,” says the survey.

Social services representatives cited obstacles to partnership,
including PCGs’ and PCTs’ preoccupations with clinical matters, the
dominance of a medical culture and service models, lack of time,
and differences in funding and budget streams.

“This is not to suggest they’re not doing anything,” said report
co-author and NPCRDC project director Professor David Wilkin.
“You’ve got organisations struggling with limited capacity to meet
a wide-ranging agenda.”

The report confirms the impression of GP-dominated
organisations. PCGs were created in 1999 to promote greater
collaboration between health and social care providers, in a move
to improve efficiency and achieve more seamless care, especially
for vulnerable groups. They were expected to evolve over time, with
all PCGs becoming PCTs by April 2004.

However, the survey finds that only one-fifth of PCGs placed
integration of health and social services among their top three
reasons when asked why they sought PCT status.

With the NHS Plan envisaging that PCTs could become care trusts,
with a remit to commission and be responsible for all local health
and social care, the report casts doubts on successful partnership
working between health and social care.

Although a small number of groups and trusts in the survey had
expressed interest in seeking “early care trust status”, there was
“no evidence” that their partnership work was any more advanced
than other groups and trusts. “There is a long way to go to realise
the ambitions for a fully integrated service as envisioned in the
NHS Plan,” says the report.

“Some people are talking of care trusts as a way of vaulting
PCTs’ obstacles,” said report co-author and King’s Fund director of
primary care Dr Steve Gillam. “But they’ve got to have a clear
understanding of what they want to do it for.”

National Primary Care Research and Development Centre and King’s
Fund, The National Tracker Survey of Primary Care Groups and Trusts
2000-1, from 0161 275 7126 or www.npcrdc.man.ac.uk