NHS Primary Care Trust

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

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NHS Primary Care Trusts (PCTs) are English statutory bodies, part of the National Health Service, responsible for delivering health care and health improvements to their local area. They grew out of committees or Primary Care Groups of the former Health Authorities (see article Strategic Health Authority). Collectively PCTs are responsible for spending around 80% of the total NHS budget.

PCTs have their own budgets and set their own priorities, within the overriding priorities and budgets set by the relevant Strategic Health Authority they belong to, and Department of Health. They directly provide a range of community health services; they provide funding for general practitioners and medical prescriptions; they also commission hospital and mental health services from appropriate NHS trusts or from the private sector. (This activity makes them the analog of "payors" in the United States). Present government directives envisage that at least 15% of services will eventually be commissioned from the private or voluntary sectors. The direct services presently provided by PCTs will also eventually be commissioned on an 'arm's length' basis.

PCTs are managed by a team of Executive Directors headed by a Chief Executive. These directors are members of the Trust's Board, together with non-executive directors appointed after open advertisement. The Chairman of the Trust is a non-executive director. Other board members may include representatives from the Trust's Professional Executive Committee (PEC) (elected from local GPs, community nurses, pharmacists, dentists etc.) From October 2006, the Chair of the Audit Committee of PCTs will also be appointed specifically on an open advertisement basis, rather than being selected by the Board from amongst the non-executive directors.

The finance and much of the agenda of PCTs is effectively determined by directives from the Strategic Health Authority (SHA) or the Department of Health.

In 2005 the Government announced that the number of Strategic Health Authorities and Primary Care Trusts would be reduced, the latter by about 50%. The result is that, as of 1st October 2006, there are 152 PCTs (reduced from 303) in England, with an average population of just under 330,000 per trust. Only the London PCTs have remained with their former boundaries. After these changes, about 70% of PCTs are co-terminous with local authorities having social service responsibilities, which it is hoped will facilitate joint planning. It is also hoped that the mergers will release about £259m in annual savings for the NHS.

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