The Director of NHS East of England Steve Clarke talks to the BBC’s Paul Stainton about how the changes planned in the NHS will affect Peterborough’s repayment of its budget deficit. Broadcast at 07:10 on Wednesday 14th July 2010 in the Peterborough Breakfast Show on BBC Radio Cambridgeshire.
PAUL: Earlier this week Health Minister Andrew Lansley announced plans to phase out Primary Care Trusts within four years and hand its powers to GPs which is worrying news for us in Peterborough of course as our PCT NHS Peterborough was overspent last year by thirteen million. So what does the future hold for Peterborough’s health care, and does it mean even more cuts in the city to pay back the loan? We’re joined by the Director of Finance for NHS East of England Steve Clarke. Morning Steve.
STEVE: Good morning.
PAUL: Basically you’re the guy that bailed us out, aren’t you? You loaned the money to NHS Peterborough.
STEVE: In effect, although it would have been loans from other PCTs in other parts of our patch in reality.
PAUL; So you’re a broker, effectively?
STEVE: You could put it that way.
PAUL: The problem is here, when will we have to pay it now, do we have to pay it back, do we have to pay it back quicker, or can we get away scot free?
STEVE: Well clearly there’s no getting away scot free. There are other PCTs who will be succeeded by GP Consortia in time who will want their money to be able to use it in their local settings. So the money will have to be repaid. The White Paper itself shouldn’t change the repayment schedule that we are agreeing with Peterborough, the PCT locally. And the plan is, and has been for some time that this debt would be cleared before the four-year period in which GP Consortia will come into being.
PAUL: Right. So there’ll be no extra pressure to repay it any quicker because of these changes?
STEVE: Not from us, although local GPs might wish to clear the debts more quickly to enable them to get moving. That would be a matter for local consideration. And I know local GPs are thinking about how they can work more closely with the PCT in what we call Practice Based Commissioning Groups, which are a kind of forerunner to the GP consortia that the White Paper talks of.
PAUL: Are you confident in these changes that they’ll work. Because obviously the PCT are supposed to be experts, and their managing of the budget in Peterborough was pretty darn awful. Are you confident that GPs can do a better job in Peterborough?
STEVE: There’ll be plenty of time for us to prepare GPs for this. And that’s one of the reasons why we’re pushing ahead with Practice Based Commissioning. The White Paper sets out ways that the future oversight decision making in the NHS can be improved by more close association of front-line clinicians.
PAUL: What does that mean? Just explain that in layman’s terms.
STEVE: That will mean that GPs are directly involved in decisions about the priorities for use of resources, which services are delivered, where, and in what way.
PAUL: So they will decide budget matters. You won’t decide that?
STEVE: That’s correct. Yes. Over time they’ll increasingly move towards GP Consortia, which is GPs collectively, not individually, overseeing the budget. So it’s not some individual GPs in that sense.
PAUL: Right. Ok. But GPs have got quite a lot of work on already haven’t they? I am still struggling to come to terms with how this is going to work in Peterborough.
STEVE: Well that’s something we’re going to have to work out with the local GPs. There’s a lot of enthusiasm from GPs to become more .. to have greater control over the use of resources in their local setting.
PAUL: I believe some have already got together to have a chat haven’t they?
STEVE: There are some working on how .. there are GPs who are thinking about how they might progress this notion over the next little while. In fact they were talking about that in advance of the White Paper, because they were using our forerunner, this Practice Based Commission approach.
PAUL: What happens if the PCT don’t pay this thirteen million pounds back to you? Does that fall on the GPs? Will they have a shortfall to start with?
STEVE: Well we’ve got plenty of time to deal with that? The plan is that ..
PAUL: What is the deadline? When does that have to be paid back?
STEVE: Well we’re looking at the two years, ten/eleven being the year in which the PCT controls its spending to the level of its resources and pays back over the next two, which will clear the debts before GP consortia come into being fully fledged in two thousand and thirteen fourteen.
PAUL: You’re expecting Peterborough’s Primary Health Care Trust to pay thirteen million pounds back over and above their budget over the next two years?
STEVE: Well from within their budget, in the two years after this the current one, yes.
PAUL: Right. So by twenty thirteen.
STEVE: Correct. Which is when the GP consortia will come into being, as I say, fully fledged. There will obviously ..
PAUL: And can you just clarify what happens if they don’t pay that back. What happens to the GPs? Where do they get their money from, that thirteen million pound shortfall?
STEVE: GPs will get their money directly from the newly formed Commissioning Board for England, and it will be a matter to be determined at that point. But I would expect that the PCT, the GP consortium in any area, will inherit the assets and liabilities to put in into financial terms, of their predecessors.
PAUL: So they could start with a thirteen million pound shortfall?
STEVE: Well no because by then it will have been cleared by the PCT, or at least ..
PAUL: Well yes. Hopefully. Thank you for coming on this morning Steve. Steve Clarke, Director of Finance for NHS East of England.