The Primary Care Group

The following is an article submitted by Dr. Meg Gilley - Chief Executive, Darlington PCG.:

Primary Care Groups (PCGs) are a pillar of The New NHS, Modern, 
Dependable , though a temporary one.  Perhaps it is better to see 
them as the scaffolding shoring up the structure while other changes 
take place.  

PCGs were born on 1 April 1999 as GP fundholding uttered its last 
gasps.  But to see PCGs as fundholding writ large is a mistake: they 
are much more than that.  Certainly, they take over the role that GP 
fundholders had of commissioning hospital and community services for 
the patients registered with the practices.  In this role, they 
retain the advantages of fundholding (the ability to influence local 
services by people who understood them) and get rid of the 
disadvantages (the perceived two-tierism, whereby patients of one 
practice could have better access to more services than patients on 
another list).  

PCGs have a wider remit.  They are also responsible for improving 
primary care, the services which surround the family doctors and 
their teams, meeting the health care needs of people in the 
community.  The NHS has found it hard to influence change in primary 
care because GPs are independent contractors.  It is difficult to 
tell them what to do, because they are not employed.  They are 
independent businesses providing services to the NHS on contract.  
PCGs will be able to use the funds available to them to support 
practices to improve the quality of premises, employ more practice 
nurses and explore innovative ways of providing services.  They will 
lead work on clinical governance, which is about ensuring the quality 
of clinical care.

PCGs are responsible for improving the health of the local 
population, and all the other aims, commissioning services and 
improving primary care, are subsumed within this.  It is tricky, 
because the factors which affect health are usually not within the 
control of the NHS (deprivation, social exclusion, and so on).  Thus, 
in pursuing all of these objectives, PCGs must work in partnership: 
· with the Local Authority (Education, Housing, Environmental Health, 
Leisure) on health promotion, 
· with Social Services on providing care to vulnerable people in the 
community, 
· with NHS Trusts on developing local health services, 
· with the public on assessing needs and monitoring services.  

For much of the 1990s, the health service was imbued with a spirit of 
competition.  A sharp distinction was made between purchasers and 
providers, and an attitude of "them and us" quickly developed.  
Though the new reforms retain the separation of purchasers and 
providers, all parties are required to work together.  Changes in one 
part of the health system have an impact on other sectors.  It is 
therefore important that developments are made collaboratively.  
Destabilising a NHS Trust by moving a contract to another provider 
threatens a whole range of other services: it is better to address 
the problems of the specialty together, rather than pulling out.

PCGs are run by Boards which typically comprise 7 General Medical 
Practitioners (GPs), 2 community nurse representatives, 
representatives each of Social Services and the local Health 
Authority, a lay member and the Chief Executive.  Formal Board 
meetings are held in public, usually once a month.  

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