'Climate of fear' mars push to create PCTs

Almost half of the 128 primary care groups and trusts which responded to an alliance survey said they were being 'pressured' into merging with other PCGs to form large independent trusts. Three separate investigations found 'a climate of fear' in the health service, alliance chair Dr Mike Dixon said last week.

The move towards amalgamating PCGs has already caused furious rows around the country. East Manchester PCG lost its battle against a forced merger with other PCGs last week, while groups in Southend were forced to merge last April, and a dispute is continuing in Morecambe Bay.

An independent report for the alliance by Professor David Hunter, health policy analyst at Durham University, found that many PCGs - all just 15 months old - wanted to achieve something for their local community before 'contemplating a big move to PCT status which will mean rearranging the furniture again and taking their eyes off the ball'. They feared being 'derailed' without 'the foundation of good management structure'. A further 'listening exercise' by the group found doctors, managers and nurses frustrated by the move from PCGs to trusts.

While staff were enthusiastic about independence from health authorities, the change process was 'too top-down'.

Dr Dixon told HSJ: 'There is a climate of fear. A lot of people are too scared to say it publicly but in at least one area the consultation was rigged against the PCG.' He said the government's policies were right, but the implementation was wrong.

Professor Hunter said PCG members largely agreed with this analysis.

'Primary care is facing the most significant change since 1948, ' he said. PCTs would play a 'key role' in driving forward the government's national plan, and it was vital to get the reforms right.

The Department of Health denied 'bullying' primary care and said the focus was on 'what is best for patients'.

A spokeswoman said: 'There has never been - and there is - no question of ministers forcing the pace of change.'

She added: 'Ministers have always been clear that forming PCTs must be locally driven and should not be a race.'

Labour MP Stephen Hesford, secretary of the all-party group on primary care and public health, blamed HA chief executives for 'over keenness' in interpreting ministers' wishes.

He said: 'They have now been told that people should be able to develop at their own pace and in their own time.'

From primary care groups to trusts: work in progress .Executive summary www.nhsalliance.org