Zitron: scrap PCTs and cut bureaucracy

Health Service Journal | By Steve Ford | 5 November 2009

The chair of a London primary care trust has proposed scrapping PCTs. He said giving their commissioning role to local authorities would be an “excellent” way of reducing bureaucracy and bringing health services closer to the public.

NHS Hammersmith and Fulham chair Jeff Zitron said in London local commissioning could be done by councils and acute commissioning through a capital-wide body. The “same principle” should be applied elsewhere in England. He told HSJ: “Not only does London not need 31 PCTs, I don’t think it needs any at all.”

Outside the capital, “local commissioning ought to be more local and more accountable and central commissioning ofacute care done in bigger units”, he said.

Scrapping PCTs in London would save £2.5m on non-executive directors, he added.

NHS Hammersmith and Fulham is one of just two PCTs to share a chief executive with the council. Herefordshire council and PCT were the first, and Waltham Forest council and PCT are attempting to merge senior management positions.

His comments follow an article for HSJ’s sister title Local Government Chronicle, in which he wrote that council commissioning health services would “strip out a layer of administration and bring health services even closer to the public.”

Joint chiefs were the obvious way forward

Local Government Chronicle | 5 November 2009

NHS Hammersmith & Fulham is responsible for the health of more than 170,000 residents, including the inmates of HMP Wormwood Scrubs. Our job is to promote healthy lifestyles and to commission services from hundreds of NHS and independent providers. 

We spend a third of a billion pounds a year, and employ around 160 staff. When I became chair in December 2007 I quickly saw that, despite largely good performance scores, we would struggle to be fit for purpose in the future. 

That is no reflection on our excellent staff team; it is about three things: first, we are responsible for health promotion but have few direct means of influencing behaviour.

Second, we are a complex organisation – in staffing, contracting, data management, ICT and more – but rely on small teams and risk ever-rising overheads.

Third, and most important of all, many of our goals – particularly in addressing health inequalities – target the same people as the council’s work in social care, housing, education or leisure.

But council colleagues have far more day-to-day contact with residents than do most NHS people.

Our track record of joint working was excellent but lacked the bite of focused leadership and accountability. Integration of the executive leadership seemed the obvious way forward.

Fortunately, the right people were in the right place.

Geoff Alltimes and Sarah Whiting are outstanding leaders, willing to take the personal risk of radical action. Both organisations attract high-calibre, creative staff who relish a challenge.

Leadership integration is here to stay in Hammersmith & Fulham. If our model works, government might decide that local health commissioning should transfer to councils and PCTs merge or be scrapped.

That, in my view, would be an excellent result, stripping out a layer of administration and bringing health services even closer to the public.

Jeff Zitron, chairman of NHS Hammersmith & Fulham