unfortunately the HAs are the only practical source of managerial resources
until PCG can train their own. I cannot seriously believe that GPs and DNs
will suddenly become skilled managers on 1st april 99!
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From: [log in to unmask] on behalf of Ruth Livingstone
Sent: 08 June 1998 04:37
To: [log in to unmask]
Subject: RE: Meeting the GMSC
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From: [log in to unmask] on behalf of PETER FELLOWS
Sent: Sunday, June 07, 1998 10:47
To: Ahmad Risk; GP-UK; DFI
Subject: Re: Meeting the GMSC
<snip>
Our LMC "PCG steering group" sees merit in trying
to promote a single county-wide "primary care group", and we will be putting
that to the full LMC next week. Pulling back to county level would seem to
me to be the only realistic way to avoid a massive increase in NHS
management costs/ management personnel, and will dilute the problems of
rationing by postcode. Let's reinvent the FPC. How many of you would go
along with that? It would be useful to have your thoughts before I try to
sell it to the GMSC.
Peter Fellows
In our area, South Lincolnshire, we would be strongly opposed to a county wide
PCG. One of the problems *we* face is being constantly overlooked when it
comes to doling out resources, due to our geographical distance from the
headquarters of our FHSA, and due to the fact that our main providers are out
of county. (For example, it seems that none of the waiting list initiative
money will come our way, because Lincolnshire Health only wants to use the
money within Lincolnshire Trusts.) I am sure there are many instances when
provision of health care on a locality basis makes sense, and where,
alternatively, the provision of health care on a county basis leaves certain
sections of the community at a serious disadvantage.
On what basis do you presume large organisations are cheaper to run? My
experience of practices is that after the practice has grown to a critical
mass (about 4 partners) any increase in partners leads to increases in
administration complexity and administration costs rise. The Kings Fund
release evidence recently that showed the optimum size for a commissioning
group was 30,000 patients. This means proposed PCG sizes of 100,000 are
already too large for efficient management, at least at level 2.
The key to success for PCG is GP control on the management boards. At the
moment, health authorities seem hell bent on retaining control. Since the WP
assumes that PCGs are going to grow in power and that HAs are going to
diminish dramatically, it has always seemed perverse (to me) to expect HAs to
preside over their own demise. Of course they will fight tooth and nail to
retain power and influence and will seek to populate the PCG governing bodies
with their own employees. We need a commitment from the government that true
power will reside with the GPs and Nurses within PCGs. It is completely
unacceptable for HAs to have control over bodies which should, effectively, be
replacing them.
--
Ruth Livingstone
http://www.stamford.co.uk/littlesurgery/
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