Wednesday, August 4, 2010


Q&A: Jeff James of the Wiltshire PCT

A recently published government white paper has announced a major restructuring of the NHS in England.

The move will lead to the abolition of all 10 strategic health authorities and the 152 management bodies known as primary care trusts.

Chief executive of Wiltshire Primary Care Trust (PCT), Jeff James, spoke to BBC Wiltshire recently to put the changes in perspective, and clarify matters.

Read the Q&A below.

What are the changes to the Primary Care Trust?

The changes that the Government is making have got three components as far as the Primary Care Trust is concerned. During the course of this year, the staff that we employ that provide services direct to patients will be transferring to other organisations. During the year that follows, we'll be working with GPs who will be the new commissioners of services - the people who plan and pay for them. They'll be working in shadow form with us as part of a phased handover. We'll also, during the course of that year, be transferring our public health work to the local authority. So by April 1, 2013, the PCT will be no more.

How will patients going to their GP see a difference?

Directly it shouldn't affect the individual patient. Although as the idea of choice and how we exercise choice grows, we may see people being more selective about the grounds on which they visit one practice over another. In terms of when your GP acts as a commissioner, what your GP is doing is making a decision with you about when you need hospital care. There will be a conversation about what hospital care might make sense and which hospital would be the best place to go to. The idea at the heart of this is that the GPs will hold budgets, but the way in which they exercise the decisions will be in partnership with you as a patient.

How real is the choice that will be offered to patients?

We collect a variety of data to look at how general practices work. One of the things we look at is how often people move from one practice to another. By and large that isn't happening an awful lot. The evidence seems to be that when people make that initial choice they tend to stay with it. The government white paper is signalling a desire to want to have more information about how well general practices do, so that when you want to make a decision about which practice to register with, you can do it based on the services they offer and the results they get rather than their geographical location.

Will these changes be empowering for patients?

The whole concept of empowerment is quite a tricky one, because apart from the desire to be in charge of your own health, not everybody feels that. Some people are quite happy to trust doctors and nurses, as they feel they are the professionals and have their best interests at heart. There are also a lot of other folk who have long-term illnesses who become experts in their own care.

What is the government trying to do over all?

There's a tendency in British health care since the early 1970s to move between two poles. On the one side there are people who emphasise health care as a system and national standard and things being the same everywhere. There's another tendency which says it ought to be local because places are different, and people are different, and more of the choices should be made by individuals and their family doctors because they're the starting point for most people's health journey. This set of changes is edging away from the NHS as a national system with most things determined at the centre, to one where there's more space for diversity and more choices being made at a local level. You still have to make difficult choices but they're locally made choices rather than nationally determined choices.

Will this improve healthcare for people?

One of the hopes that the government have is that choice, and the conversations that happen between individual patients and GPs, will mean that they'll start to think about answers that we don't have in the current system. There are good parallels for this in social care. In the social care world we've started to think about what would happen if, instead of having the services that were routinely available, we've said to a person, OK here's the budget that's available for your condition, what would be the right package of things for you? And giving more choice that way.

Could tax-payers money be spent on non-scientific treatments such as homeopathy?

The hard scientific evidence, typically the controlled trial model, is a relatively modern phenomenon and tends to be applied very much in the pharmaceutical sphere, so it's important for us to recognise that it's not as though everything we currently do is empirically verifiable in that way. What we're rubbing up against here is two sorts of ideas, one is that we should think about people in machine terms, and therefore the language of science is entirely appropriate. The other is that we should think about people holistically, and therefore their sense and their feelings are as important as what you can measure in hard scientific terms. Now often is the case in terms of things like homeopathy that when you hear the conversation about it, the person's experience is as much as how they're treated as an individual is as much a part of the homeopathic package as is the homeopathic remedy itself. So we need to be careful to tease out whether what we're hearing is something important about the context in which complementary therapies are made available, as distinct from the active therapy itself. We might be learning something important about the social setting for care that matters in terms of how well people feel.

Do you believe the model will deliver a better healthcare system?

I think it's a model that can deliver, because if you look beneath the surface, underneath all of this are ideas that look quite like models that work elsewhere. There are models of health maintenance organisations that work in the United States, where you have a combination or primary care and secondary care being run through a single system. They have similar ideas about wanting to ensure that you have active partnership with patients at the core of it. You do as much treatment away from hospital as possible and you encourage people to take as much responsibility for their care as possible. Many of the HMO's that operate on that model in the States are very successful.
Story from BBC NEWS:

Published: 2010/08/03 12:23:55 GMT