Monday, 2 August 2010

Public questions for the July 27th PCT Board

Dear Chairman
Public questions for the July 27th PCT Board

1. The agenda for the July 27th Board of NHS Richmond includes its ‘Integrated Governance Annual Report 2009/10’, dated July 16th, i.e. after the White Paper. The Report’s chapter on ‘Practice-based Commissioning Prescribing’ (top of page 31) carries a remarkable and most welcome statement that “this will now mature as NHS Richmond begins to establish itself as a World Class Commissioner.” And so say all of us! NHS Richmond, it's PCT – and its team from the Board down – is one of Richmond’s success stories. Now is not the time to give such a long-experienced team the go-by.

1.1 Contrary to this week’s Richmond & Twickenham Times – with its inaccurate reports on “hospitals moving out of the NHS” and on the “PCT, NHS Richmond, ceasing to exist by April 2013” (wrongly ‘confirmed’ by the PCT’s spokesman) – the White Paper says something very different. It only “expects PCTs will cease to exist from 2013” and then only when “GPs have been successfully established.”

1.2 Moreover, the Coalition Government is adamant that “Implementation will happen from bottom up.” If Richmond has better ideas on how the NHS might develop, then so be it!

1.3 Does the PCT Board – and its partners – not agree that the basic question it faces is this? How should NHS Richmond evolve from its present PCT status to achieve the principal objectives of the White Paper? Evolution, not abolition has to be the order of the day for the restructuring process now underway. Increasingly NHS Richmond should regard itself as an embryonic GP consortium in the making.

1.4 Putting GPs in the driving seat has to be commended. No clinician (or statutory officer) has a more direct, wider and more balanced understanding of the health needs of patients. Many will be reluctant but there are enough GPs in Richmond’s 31 practices able and willing to undertake and develop this role. GPs are well aware that the PCT has all the budget-balancing and other decision-taking skills that their consortium will need.
1.5 The Government’s ‘deficit and mounting debt’ has to be the main problem and doubts clearly exist within Whitehall that PCTs, including NHS Richmond, are too closely associated with the profligate bureaucracy of recent years to be entrusted with the “45% saving of managerial costs required in the next 4 years.” It would be up to NHS Richmond, old and new, to prove the doubters wrong, or does its top team, with its record of success in assiduously following Whitehall dictates, want to end their days on a note of failure and resignation?

2. The “End State Process and Timelines” of Hounslow and Richmond Healthcare, HRHC, is featured in Agenda L. Despite misgivings, it is to be hoped that HRHC is “given the go-ahead to pursue the standalone option”, para 3.3.

2..1 If, however, the review does not support this option, then formal consultations will be necessary that include consideration of the social enterprise model adopted by Kingston. Would the Board please confirm that in the event of a standalone veto from the SHA, it would be its intention to hold such consultations? A repetition of the NHS inadequacies on consultation, covered in the May 25th minutes, is in nobody’s interest.
3. It is of note and concern that, to date, the PCT’s governance department has been unable to confirm the correct date when the Board decided to ‘delegate’ its key strategic functions to the Joint PCT of SW London.

I hope to be able to attend the meeting.
Yours sincerely



Francis King

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