Shared boundaries to be broken up by health service restructuring

Coterminous relationships between councils and primary care trusts look set to be broken up in north east and south west England and Essex.

But most of the plans submitted to the government by strategic health authorities to restructure PCTs promote or maintain shared boundaries between councils and trusts.

The results confirm expectations that government plans to slash the number of PCTs from 303 would support joint working in most areas but might obstruct it in others.

The arrangements under threat include those in Bath and North East Somerset, Darlington, Hartlepool, Middlesbrough, Newcastle upon Tyne, North Somerset, North Tees, North Tyneside, Northumberland, Redcar and Cleveland, South Gloucestershire, Southend, Swindon and Thurrock.

In Northumberland, this could involve dismantling the care trust set up in 2002 and creating a PCT that would also cover Newcastle and North Tyneside.

And Thurrock Council has shelved plans to form a care trust with its PCT as a result of proposals from Essex strategic authority that would remove coterminosity between the two.

However, of proposals affecting 100 of the 150 top-tier councils, seen by Community Care, nearly three-quarters could result in perfectly coterminous arrangements.

In most of the others, new PCTs would map directly on to two to four local authorities, while Birmingham Council would envelop three trusts.

In London, fears that coterminous arrangements would be dismantled have been temporarily allayed (news, page 6, 13 October). The five strategic authorities have proposed two options: coterminosity across the capital or fewer multi-borough PCTs.

Consultation on the proposals will continue until next March and the restructuring should be completed by October 2006.

It is the first stage in a process to overhaul the NHS, which will also include divesting PCTs of their role in providing services by 2008.

Although one of its key objectives has been to promote integrated working between health and social care, this has run up against the government’s desire to slash PCT administration costs by 15 per cent through mergers.