Meeting the information and budgetary requirements of primary care groups.

Primary care is experiencing another wholesale reorganisation as the government’s “new NHS” is implemented. The intention is to bring general practitioners and other healthcare professionals together at a local level to assess the needs of their shared populations and to ensure that resources are allocated to meet those needs. The mechanisms chosen for England (primary care groups) and Wales (local health groups) have more in common than those for Scotland (primary care trusts and local health care cooperatives). The differences among the three countries represent a worrying fragmentation of “national” health service structures. Primary care groups (PCGs) are not voluntary; all general practitioners are members of a primary care group. Shadow groups started operating at the end of October 1998 and go live in April 1999. Their three main areas of responsibility include the development of primary care, the commissioning of secondary care services, and a quality agenda delivered under the umbrella of clinical governance. Only level 1 and 2 groups will exist from 1999; primary care trusts, described by one civil servant as “PCGs in long trousers,” with their wider remit to include community health services, will not start until 2000. Current NHS community trusts, together with primary care groups, will be able to bid to progress to primary care trusts. Level 1 groups will have a largely “advisory” role in the commissioning of secondary care services. Level 2 groups, in contrast, will take charge of at least 40% of their unified budget to purchase secondary care services. The government’s stated aims for all levels are similar: tackling variations in quality of care and distributing NHS cash more fairly. “The healthcare needs of populations, including the impact of deprivation, will be the driving force in determining where the cash goes.” Few will argue with these aims, but clearly any redistribution exercise will mean winners and losers, and the pace of change towards fair target shares will be all important if local services are not to be destabilised. After negotiations between health minister Alan Milburn and the General Practitioners Committee (GPC) in June, general practitioners locally were able to choose whether they wanted to form the majority on their primary care group board and have it chaired by a general practitioner; most voted for this high degree of participation. Given that primary care groups will work with a cash limited unified budget, derived from the existing separate budgets of the hospital and community health services (£23bn (thousand millions) nationally), prescribing (£4bn), and GMS Cash Limited (GMSCL) (£1bn), it is essential for general practitioners to understand the principles of resource allocation. The idea of a unified budget originally generated immense anxiety. General practitioners were at risk of personal financial loss if there were reductions in the GMSCL budget, which reimburses a large part of general practitioners’ committed expenditure on staff, premises, and computers. The GPC successfully negotiated protections for the GMSCL, guaranteed by the health minister.