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Notes from NHS Networking Lunch for Deputy Directors from PCT's and Provider Services organisations - 15th April 2010

The future of PCT’s is in question.

20 years since the purchaser/provider split and questions again are being raised over how to create competition and increased service delivery within the NHS. Do the benefits reaped in patient care justify the transaction costs inherent in the system? What can PCT’s do to affect the quality of care given by Providers, and through efficiency and best working practices, can they better serve the population they represent?

Following on from the lunch we held with Acute Trust DDoF’s last week, Morgan Law has brought together Deputy Directors of Finance from with PCT’s and Provider units to discuss the next 12 months and beyond.

Despite representing different sides of the fence, as you would expect, themes and topics of discussion are similar.

CQUIN is a popular topic, as it widens the debate that surrounds PCT about the payment landscape that has developed over the course of the last decade and the argument of what levers PCT’s have that can influence a Trusts behaviour.

Sotiris Kyriacu (NHS London) reminds us that for CQUIN to work efficiently work as a lever it has to be taken seriously and that it is based on patient care not being compromised, which is the only way it can work.

There are thoughts however that as a payment framework, there are issues inherent in it, that are symptomatic of NHS initiatives over the course of the last 20 years which don’t assist PCT’s in practical implementation. Consensus is that some measures will be hard to quantify and the data going in is not always the best, which adds up to Raj Soneji (Luton Community Healthcare) – not being sure if CQUIN is the ‘Carrot or the stick’.

PbR was never far from the agenda. It has caused many Commissioners Orghanisations problems, which cannot be fixed internally, the notion that PbR is more accurately described as Payment by Activity, rather than results is seen as a problem that cannot be overcome simply by efficiencies and corporate cost cutting. The view that partly because of the weakness of commissioning, hospitals have an incentive to generate more activity to increase their income is prevalent.

David Avis (Harrow PCT) suggests that local agreement of contracts is an option that has been known to work well, and that could let PCTs commission more effectively and efficiently.

The cost savings of PCTs that have been mooted of up to 30%, are obviously of concern to the floor. The integration of Provider arms into Acute settings do mean cost reduction in terms of senior level executive staff, as well as mid level accountants, and would make a significant contribution to PCT’s efficiencies targets, but consensus is that the initial £75m target for standalone Provider organisations was optimistic at best.

Efficiencies require proactive measures said Andrew Strevens (Hampshire Community Health).

The taboo of negotiating PFI contracts, he says are one area in which potentially large savings can be made, and many are surprisingly open to re-financing. It is in this way it is suggested, that PCT’s will have to think moving forward, the status quo’s must be challenged to generate such drastic savings. Another recurrent theme to improved results is gaining clinical engagement, and having clinicians and GP’s leading the drive for efficiencies, the view that finance can no longer be a backroom function, the partnership between frontline and corporate functions must be just that – a partnership.

General consensus is that PCTs are coping well amongst a climate that doesn’t do much to help them and if the purchase/provider landscape is going to work, and financial savings are to be made, that there must be help from the DoH to provider a framework where PCTs can incentivise Providers to improve patient care.

Cuts will be made, this is clear and inevitable, but what is imperative is that PCT’s are given adequate standing to improve their situation against the backdrop off an Acute sector eager for more income.

PCT’s have had a rough ride, certainly, and this will continue, and from a Deputy Directors professional point of view, keeping a workforce and team motivated to produce results has been challenging, but what is clear is the desire to improve the quality of patient care and experience and the belief in the ability to do so.

For more inforamtion about this networking event and others that Morgan Law are organising to support your network within your sector, please contact Lara Knights on 0207 747 4397.