Just over two years ago, 303 primary care trusts were created in England, each with responsibility for providing primary health care, improving health, and commissioning secondary care services for a population of around 180,000.

Hopes were high that these new organisations would be powerful agents for change in a more devolved and locally responsive NHS. But some in the NHS now believe that primary care trusts have failed to fulfil these expectations and are suggesting a further reorganisation, with mergers, to reduce their number to 100-150 across England.

So what would these mergers achieve?

There is no good evidence to show that a structural reorganisation of primary care trusts would bring benefit to patients, write Professor Kieran Walshe and colleagues. The rush to reorganise and merge also fails to recognise that many primary care trusts have already made some progress.

Reorganisations are a clumsy reform tool, and research shows that they seldom deliver the promised benefits, they add. Every reorganisation produces a transient drop in performance, and it takes a new organisation at least two to three years to become established and start to perform as well as its predecessor.

Yet the NHS is reorganised every two years or so, which probably means it sees all of the costs of each reorganisation and few of the benefits.

To propose making structural changes to primary care trusts is premature. What they need instead is the space to work on implementing current policy initiatives and seeing their effects, building relations in local healthcare communities, and securing much needed clinical engagement and improvement in service.

The Department of Health and NHS managers should resist the temptation to reach for the old panacea o
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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ-British Medical Journal
14-Oct-2004