 There is no question that professional executive committees (PECs) need
to change in order to reflect the developing roles of primary care trusts
in England. The debate now is what these new PECs should look like and
what will be their roles and functions.
The outcomes of a review “Fit to lead”, which was carried out by
the NHS Alliance on behalf of the Department of Health, were published last week
in the form of a consultation document. The alliance collated and analysed the
opinions and experiences of key stakeholders, including PEC chairmen and members,
chief executives and their management teams, health professionals and external
stakeholders, to produce the document, which will be out for public consultation
until February 2007.
Over 60 per cent of PECs have appointed a pharmacist since 2004 and several of
these pharmacists have gone on to become PEC chairmen and vice-chairmen. Mark
Bulmore, a pharmacist and chairman of the professional executive committee at
South East Essex Primary Care Trust, told The Journal that pharmacists must be
represented on the new PECs in order for primary care trusts to fully implement
the Government’s White Paper “Our care, our health, our say”. “Pharmacists
have been for years part of communities where they understand patient needs and
can deliver health care in an easily accessible manner. They know how to design
and deliver services that patients want,” he says.
The review makes it clear that a one size fits all approach is not desirable.
New PCTs vary hugely in the populations they serve, so there is a need to set
principles but allow local variation, it says.
In terms of membership, most contributors believe that this should remain multiprofessional,
but should be smaller, with four to eight professional members. The review says
that professional bodies representing allied health professionals, dentists,
nurses and pharmacists all put forward convincing arguments why their professions
should be represented on the PEC. However, it adds: “A balance needs to
be reached between multiprofessionalism and the benefits that brings, with maintaining
a size that is functional and able to operate in a focused way.” It suggests
that rather than representing a professional group, PEC members should be appointed
on the basis of their likely contribution and skills, have clear job descriptions,
key lead areas and tasks, and should be accountable for their delivery.
The review highlights that the PEC represents one part of the spectrum of clinical
engagement within a PCT rather than the sole means for professionals to be engaged.
Contributors to the review are clear that clinical members should be practising
professionals with a caseload. Many believe that a poor level of appropriate
skills among PEC members has contributed to their poor performance in the past. “The
focused strategic role, together with functions such as developing and managing
the market, requires professionals who, rather than representing their own professional
constituency, can draw on their professional perspectives and blend them with
other skills including leadership,” it says. The review adds that the selection
process should be more rigorous and appointment should be by interview. Most
stakeholders also believe that remuneration must reflect the responsibility and
importance of the posts and must be equal for all members.
Pharmacy bodies’ views
The Association of Independent Multiple Pharmacies, the Company Chemists’ Association,
the National Pharmacy Association, the Pharmaceutical Services Negotiating
Committee and the Royal Pharmaceutical Society produced a joint response
to inform the review. In it, they highlight the inherent conflict of
interest in many practices taking on both a commissioner and a provider
role under practice-based commissioning and argue that the new PEC could
play a key role in scrutinising decisions made within commissioning groups.
They contend that one of the reasons why PECs have not delivered more
innovation is because they have been, for the most part, dominated by
one professional perspective and focused on the existing model of service
delivery. “As far as the pharmacy bodies can see, PBC may simply
replicate this problem at local level. It is for this reason that the
PCT has a duty to put in place a strong PEC that can effectively scrutinise
the decisions of commissioning groups.” To be effective in this
new role, they say, the PEC should be a cross professional and sectoral
forum involving providers and frontline clinicians rather than PCT employees.
No one profession should be in the majority. “Likely members would
be generalists and include representatives from relevant sectors who
command the confidence and support of their peers.” They suggest
that where commissioning plans for more specialist services are being
assessed, representatives from these specialties could be seconded to
the PEC.
In areas where there have not been pharmacist members on PECs, Mr Bulmore
sees the consultation as a clear opportunity to promote their worth.
In areas that have had pharmacist representation, pharmacists should
respond to the consultation in order to ensure that this valuable role
continues in the future as it has done in the past, he says.
Before the recent reconfigurations, Essex had 13 PCTs, all of which had
pharmacist representation on their professional executive committees. “It
is almost certain that we will have pharmacist representation on the
PECs of the five new reconfigured PCTs, three of which will be at PEC
chairman level.” This, says Mr Bulmore, is down to the efforts
of individuals who have worked to build relationships locally and through
the local pharmaceutical committee, which has been proactive in engaging
with PCTs to promote the benefits of pharmacy involvement in PECs.
Other themes in the review
Stakeholders agree that the PEC needs to shed some of its broader
roles so that it can focus on strategy and the core business of
the PCT. However, they believe that the new PEC should play a strategic
role wherever it is able to add value and should not be restricted
to clinical issues. There is wide agreement that it should have
a decision-making rather than an advisory role. Key functions will
be: setting and communicating the vision and strategic direction
of the PCT; commissioning and managing the market; clinical effectiveness
and clinical governance; and leading communication with partners
and stakeholders.
Contributors also say that new PECs must harness the factors that
have made some of the current models a success, one of which is
good relationships with the senior management team. There is also
agreement that the new PEC is key in facilitating and driving practice-based
commissioning, a role which is likely to change as PBC matures.
Many stakeholders say that the future of the PEC will depend upon
establishing a clinical leadership career structure within the
NHS. |
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The
Pharmaceutical Journal