As PCGs become PCTs, lay members are demanding higher pay. Without it, they say, the only people we'll see serving on these lynchipins of primary care reform are the 'usual suspects'. Claire Laurent reports

Money and influence. Everyone wants them. And lay members on primary care groups appear to be no exception.

The newly launched National Association of Lay People in Primary Care is lobbying for both. It believes that as PCGs move to primary care trust level, lay PCG members should fight for a place on the executive committees of trust boards - and increased payment for their time.

Currently with a membership of around 100 (out of a present potential of over 480), the association is lobbying for changes in the board structure of PCTs.

It wants them to have a single trust board, to take on the functions presently divided between the trust board and the executive committee.

According to its policy paper, this would 'retain the best of the PCG experience'. Association chair Dr Nicholas Reeves, a lay member of Acton and Central Ealing PCG, says under the current guidance the executive committees will be weighed down with professional people without the contrasting view of the health service that lay people bring. He said it was important to recruit 'people who have really strong roots in the community to counteract the health service clinicians and the professionals'.

To those who point out that the trust board will have a lay chair and five non-executive members, Dr Reeves says it only takes a powerful chair and chief executive on the executive committee to 'manage' the trust board.

And issues about time commitment and remuneration of lay people and non-executive directors means that 'management' is made all the easier.

Dr Reeves, whose doctorate is in history, says the recruitment process of lay people to PCTs, smacks of the 19th century, not a modernising 21st century.

He says the wide discrepancy between the remuneration for the lay chair of the trust board, (£12,589 per annum for a level 4 and£10,071 per annum for a level 3 trust) for two-and-a-half days a week, compared to£21,822 for the chair of the executive committee for the same workload, plus an additional locum payment of£11,000, tells its own story.

No ordinary member of the local community could afford such a commitment, says the association, calling for 'notional' payments for the 'great and the good'to be abandoned for proper remuneration.

Dr Reeves says: 'I'm not naive enough to think there is a clear easy solution as you move away from people working in an entirely voluntary capacity to a capacity in which they are paid.

But. . . if PCTs are to serve their local communities you have to put in place the practical things, the money, the training, for people to make that commitment.'

Dr Mike Dixon, chair of the NHS Alliance, says the recruitment process to become a lay member is so complex that it intimidates the ordinary person and that PCTs needed to take responsibility for making sure that local people were able to apply, rather than 'the usual suspects'.

Not all lay people share the level of concern voiced by the Association. Nick Georgiou, lay member for Oxford City PCT, says it was up to PCTs to read the guidance constructively.

'I obviously subscribe to the notion that lay people do need to have a good strong voice and certainly need to be on the executive committees, but you could perfectly well reconstruct the notion of non-executives to make that read 'lay'' he said.

But Nigel Edwards, policy director of the NHS Confederation, suggests that having one or two lay people on the executive committee surrounded by professionals was not 'a terribly effective way for lay views to be taken into account'.

Between the new patient advocacy liaison service (PALS), patient forums and non-executive directors, there would be no shortage of lay views, he reckoned. And Mr Edwards warns: 'If executive committees are not taking proper cognisance of views of patients it will come back to bite them.'

One of the first wave primary care trusts, Hillingdon PCT, is made up of three PCGs - North Hillingdon, Uxbridge and West Drayton and Hayes and Harlington. Each PCG remains in the shape of a 'locality directorate', which is the equivalent to the executive committees.

The trust board has eight non-executive directors including the chair and the three chairs of the locality directorates. Each locality directorate has seven GPs (including the GP chair), two nurses, social services representative, two lay members and a full time director and PCT non-executive director.

The directorates are known as the 'engine rooms' and the community staff have been assimilated into each of these. According to Micheline Smith, lay member for North Hillingdon locality directorate, 'the directorates drive the agenda and management decisions are not top down.'

She believes this system means that 'the local flavour and expertise is maintained'. By keeping lay members at the executive level, where many decisions are taken, contact with local people is continued, which leads to a more responsive organisation.

The National Association of Lay People in Primary Care.

020 8567 4451.