Lansley reforms mean paralysis for patients

As a patient, do I care that the primary care trusts (PCTs) are to be demolished and replaced by GP commissioning consortia? On one level I do, because I have to ask myself whether the change is going to improve my care and patient safety in general. On another level, I couldn't care less, as I never really discovered what PCTs actually did. Doubtless it was deplorable for me never to bother to find out. My few impressions of PCTs include the Dr Urbani case, when a PCT hired a German doctor who, in 24 hours, got the decimal point wrong in his dosage of a patient, who died. I also remember a PCT in the New Forest mismanaging the finances of several cottage hospitals, which had over the years treated several members of my family. More recently, I blame my local PCT for not realising what a star my GP's practice is in having created a paperless surgery about five years ago. The PCT should have realised that my GP would have liked to have been a pioneer user of Choose'n'Book. But it gave no encouragement, with the result that my GP became a late and unenthusiastic adopter. So, my anecdotal and superficial impressions of PCTs are somewhat negative. But, being a fair-minded sort of chap, I feel there must be another side to the story. I would be grateful if a PCT fan could put up a robust defence of what they have been doing in the 11 years since they were created, and why their function cannot be replaced by GP consortia. I am convinced that they must have a case, which nobody has yet presented. I gather that one of the PCT functions was to "work with local authorities and other agencies that provide health and social care locally to make sure that your local community's needs are being met. PCTs are now at the centre of the NHS and control 80% of the NHS budget. As they are local organisations, they understand what their community needs, so they can make sure that the organisations providing health and social care services are working effectively." Did they do that effectively? If they did, I can't imagine that Andrew Lansley's consortia of GPs will do it any better. I have a nasty feeling that healthcare and social care will be less joined up than they were. And that is bad news for geriatrics like me. My GP tells me that the staff of our local PCT have stopped making any new initiatives and spend their time job hunting. I don't blame them, but it does mean that primary care will grind to a halt. Worse still, the whole shift from PCTs to consortia will last until 2013. That is particularly bad news for me, as the Office for National Statistics' life expectancy figures ( link ) show that I have just passed the sell-by date for my area. I can expect no progress in the next three years on implementing the technologies, electronic health records and telehealth that will keep me alive. The GPs will be too busy reorganising themselves and mastering the mysteries of accountancy.