PubMed · 10120224
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S Parker. 1991. Mandated coverage: a system reaction.. https://pubmed.ncbi.nlm.nih.gov/10120224/
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The latest NHS reorganisation proposes that doctors in trusts should be given more managerial responsibility. Attempts to Involve doctors in NHS management over the last 10 years have not been wholly successful. The constant reorganisation of the NHS hinders the integration of clinicians in management.
BACKGROUND: The study is designed to assess the organisational and human resource challenges faced by Primary Care Trusts (PCTs). Its objectives are to: specify the organisational and human resources challenges faced by PCTs in fulfilling the roles envisaged in government and local policy; examine how PCTs are addressing these challenges, in particular, to describe the organisational forms they have adopted, and the OD/HR strategies and initiatives they have planned or in place; assess how effective these structures, strategies and initiatives have been in enabling the PCTs to meet the organisational and human resources challenges they face; identify the factors, both internal to the PCT and in the wider health community, which have contributed to the success or failure of different structures, strategies and initiatives. METHODS: The study will be undertaken in three stages. In Stage 1 the key literature on public sector and NHS organisational development and human resources management will be reviewed, and discussions will be held with key researchers and policy makers working in this area. Stage 2 will focus on detailed case studies in six PCTs designed to examine the organisational and human resources challenges they face. Data will be collected using semi-structured interviews, group discussion, site visits, observation of key meetings and examination of local documentation. The findings from the case study PCTs will be cross checked with a Reference Group of up to 20 other PCG/Ts, and key officers working in organisational development or primary care at local, regional and national level. In Stage 3 analysis of findings from the preparatory work, the case studies and the feedback from the Reference Group will be used to identify practical lessons for PCTs, key messages for policy makers, and contributions to further theoretical development.
A three-year in-depth evaluation of 12 PCG/Ts shows that much remains to be done in terms of commissioning. PCG/Ts need to be more active in tackling poor performance. Further delegation of responsibilities from health authorities to PCTs will be a challenge, given their reluctance to tackle service changes. GPs tend to dominate board meetings. More resources are needed for management support.