Coalition plans could test health and social care links

Moves to integrate health and social care in England may be put to the test under coalition government plans for primary care trusts and GPs, it has emerged.

Though the government has not explicitly promised this, the NHS Confederation is predicting the creation of fewer and larger PCTs that would cover a number of local authorities.

Shared boundaries between individual PCTs and councils – which apply in most cases – have historically been seen as important in driving integration.

The coalition’s programme for government outlines plans to cut NHS administration costs by a third, which the confederation said implied reductions in PCT numbers.

The coalition also plans to shift a number of PCTs’ existing commissioning functions to GPs or GP consortia, with PCTs commissioning “residual services” that are best undertaken at a wider level and taking greater responsibility for public health.

Jo Webber, deputy director of policy at the NHS Confederation, said this pointed to councils developing a closer relationship with GPs, saying there was a “strong likelihood” of more social workers being based in GP practices.

Steve Field, president of the Royal College of GPs, also predicted more social workers being based in GP surgeries. He added that it was sensible to allow GPs to commission care as they were at the “front end” of primary care.

Field said the college had been encouraging the concept of federations of practices for many years and added that it was time to see closer working between GPs and local authorities along the lines of councils’ current links with PCTs.

However, he added that it was important to maintain the close links developed between PCTs and local authorities, with councils set to have an enhanced role within public health under the coalition’s plans.

Andrew Cozens, the Local Government Association’s strategic lead for adult social care, added it was unclear what the changes would mean for the relationship between local government and the NHS in children’s services.

Other coalition plans include for PCTs to have board members who are directly elected and others appointed by local authorities. Currently all are appointed centrally.

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