Annex

Primary Care Trusts

1.The Government will establish a new form of Trust - the Primary Care Trust - for Primary Care Groups which wish to be independent and are capable of being so. The Government will issue detailed proposals for discussion in due course, but such Trusts could be managed by a board of GPs (drawn from the practices involved), community nurses and managers, and include social services and lay members. The Trust would hold the resources for General Medical Services cash-limited allocations, hospital and community health services and prescribing. One option would be for the Trust to hold a wider range of resources under the so-called 'unified budget' option under the Primary Care Act. GPs who wished to retain their existing independent contractor status under Part II of the (1977) NHS Act would do so.

2.Community health services, and in many cases the NHS Trusts which provide them, will have an important part to play in contributing to the work of Primary Care Groups in commissioning services and in integrating their provision with that of primary care. There will be scope, where a Primary Care Trust is established, for appropriate community health services and their management to become an integral part of the Trust.

3.In such cases it is envisaged that the Primary Care Trust will employ all relevant community health staff and run community hospitals and other community facilities, ensuring these work effectively as part of an integrated system. The precise arrangements will, however, depend on local circumstances.

4.The new Trusts will not be expected to take responsibility for specialised mental health or learning disability services.

5.The Government envisages that the criteria for a Primary Care Group to become independent would include:

•proper arrangements for financial accountability, including the appointment of the Chair or Chief Executive as the Accountable Officer, and arrangements to ensure the Trust balances its budget and meets its cash limit

•well developed arrangements for monitoring activity and developing practice-level clinical standards

•making an effective contribution and working within the Health Improvement Programme set by the Health Authority and partner organisations

•agreed standards and targets set with the Health Authority

•broad support locally for the establishment of such a Trust, including amongst those GPs affected.

Primary Care Trusts will be accountable to the local Health Authority.

The Government will evaluate early progress with these arrangements before enabling them to evolve generally.

(c) Crown Copyright 1997

Book Title: The New NHS White Paper