An increasing disengagement of GPs from their primary care trusts is threatening to thwart the government's plans for an NHS led by frontline clinicians.

The message is contained in a new report by the primary care group the NHS Alliance and endorsed by the BMA's GPs Committee, which suggests PCTs are too unwieldy and dominated by managers, hampering the empowerment of frontline doctors, nurses and allied health professionals.

"The government said they were going to put local doctors and nurses in the driving seat. That is no longer the case. It is being driven by others," said Dr Julian Neal, author of the report.

The NHS Alliance found widespread disillusionment among doctors not included on PCT boards or Professional Executive Committees, leading the NHS Alliance to call for clinician engagement to be included in the government's performance rating system.

The first ever 'star ratings' for PCTs were published in July, but were heavily criticised by primary care leaders for distorting clinical priorities towards meeting waiting list targets and not taking local variations into account.

But the NHS Alliance says that its members now accept that performance indicators are here to stay, and that the inclusion of clinician engagement would make PCTs concentrate on overcoming barriers to greater empowerment and inclusion of frontline staff.

Putting local GPs and nurses in the control seat is thought to require additional managerial and administrative support, for which the Department of Health has vowed to offer the skills, support and development needed.

The report also recommends allowing input from PCT clinical leaders at Strategic Health Authority level and a new push to ensure that the re-design of services and the resourcing of them - are led by primary and secondary care clinicians. Freedom to innovate at PCT level and the aligning of three year plans with budget allocations over the same period were also proposed as vital improvements.

The NHS Alliance says it is already in discussion with the Commission for Health Improvement (shortly to be succeeded by the Commission for Healthcare Audit and Inspection) to update PCT indicators, with some measure of clinician engagement likely to be included.

pharmafocus@pharmafile.co.uk