Organisation Development in Health Care

Strategic Issues in Health Care Management

Huw T.O. Davies, Mo Malek, Rosemary K. Rushmer

• Publisher: Taylor & Francis
• Year: 2017
• Print ISBN: 9781138704947
• eBook ISBN: 9781351785211
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

This title was first published in 2002: Health systems across the globe face similar problems: controlling costs while maintaining or improving health care quality and access. Notwithstanding the unprecedented health system reforms of the past decades, many outstanding problems remain in these areas. Drawing on experts from Europe and America this eclectic collection of leading edge research examines the impact of organizational development on improving quality and efficiency in health care. A series of chapters provide accounts of organizational reconfiguration in the UK and elsewhere. The contributors examine how structural and procedural changes must be matched by the development of human resource services if increases in efficiency and effectiveness are to be achieved. The book will be of interest to health care academics, policy makers, managers and practitioners who are interested in keeping abreast of the latest developments in health care research.

SECTION ONE INVOLVEMENT AND PARTNERSHIP ARRANGEMENTS

Chapter One

Primary Care Groups – What are They and Why are They Here?

Lawrence Benson and Gillian Wright

Understanding PCGs

This chapter rejports a study which explores factors affecting (inhibiting or promoting) the development of corporate board teams within complex and hybrid public sector organisations through a period of continuous transformation. The study takes executive board members for English PCGs as its unit of analysis for the period 1999 to 2002. This chapter explores the ways PCGs see their structure and objectives. It reviews the process of the formation of PCGs and presents an agenda arising from their nature which makes them a particularly interesting focus of research. The chapter summarises relevant literature, describes the research methods to be employed in the programme and presents results from the first phase of the study.

Establishing PCGs

The UK’s National Health Service (NHS) is in a period of major reorganisation and probably this is no more radically felt than within the primary care sector. The current strategic direction for this attempt at health care reform can be found in the government White Paper The New NHS, Modern and Dependable (Department of Health (DoH), 1997) which addresses the NHS in England and this has heavily influenced health policy reform in other parts of the UK for example Scotland (Scottish Office DoH, 1997).

The purpose and role of PCGs in England and the NHS was announced in the government White Paper for England as bringing together: Primary Care Groups comprising all GPs in an area together with community nurses will take responsibility for commissioning services for the local community. They will work closely with social services. There will be four options for the form that Primary Care Groups can take … including the opportunity to become freestanding Primary Care Trusts, with responsibility for running community hospitals and community health services (DoH, 1997).

There are four levels of PCG outlined by government (ibid.) although PCGs were only initially established from April 1999 at levels 1 or 2.

Table 1.1 Four levels of PCG

Level	Status	Role	PCG/PCT
Level 1 from April 1999	Advisory subcommittee to the local Health Authority	Advice on commissioning health services for resident population	PCG
Level 2 from April 1999	Subcommittee to the local Health Authority with devolved responsibility	Commissioning some health services for resident population	PCG
Level 3 from April 2000	Freestanding public body – nationally accountable to the Secretary of State, locally accountable to the local health authority	Commissioning some health services for resident population	PCG and PCT
Level 4 from April 2000	Freestanding public body – nationally accountable to the Secretary of State, locally accountable to the local health authority	Commissioning health services and providing some community health services for resident population	PCG and PCT

PCGs are thus seen by government as a major initiative to formally institutionalise collaboration and partnership. This trend of being formally required to work in partnership is now evident across UK health and social care (DoH, 1997, 1998). Thus the effectiveness of institutionalised collaboration has become a major focus of practice and research within UK public sector management.

PCGs are of interest as a research focus for a number of reasons as noted in Table 1.2.

Table 1.2 PCGs as a research focus

Newness	The invited debate about their newness of approach (Maynard, 1998)
Scale	The national scale of the policy initiative; all England to be covered by PCGs from April
Roles	The declared breadth of the role of PCGs encompassing potentially both provision and commission of health services
Formality	PCGs as an initiative which formally institutionalises collaboration and partnership in government
Membership	The wide membership of their executive boards and the consequent mix of organisational cultural back grounds
Transitional period	The period of transition of shadow and live PCGs (including PCTs) from 1998 to at least 2002

The Nature of PCGs

The details of PCGs noted in Table 1.3 demonstrate the variety in their size/ scale. Overall, the government intention of PCGs serving 100,000 local residents has been largely realised from April 1999. The level of complexity within most PCGs is made apparent by the large number of GP practices working within their boundaries. There is also some evidence of an apparent inequality regarding the availability of resources targeted for the management and organisational infrastructure of PCGs.

Membership of PCG Boards

PCG boards for levels 1 and 2 are multi-professional, GP-dominated, tied with existing organisational structures (subcommittees of the Health Authority) and have new categories of membership from outside health structures, e.g. social service and lay representation.

In respect to the board membership at levels 1 and 2 this consists of:

• four to seven general practitioners;

• one to two nurses working within the community;

• one local authority social services officer;

• one lay member to represent local people;

• one health authority non-executive director;

• one chief executive officer (ex-officio membership);

• the overwhelming majority of PCGs are chaired by a GP.

Table 1.3 The nature of PCGs – April 1999 to October 2000

Population served
Government envisaged size of PCGs	100,000 residents
Average size of population served by a PCG from April 1999	107,000 residents
Minimum size of population served by a PCG from April 1999	47,000 residents
Maximum size of population served by a PCG from April 1999	278,000 residents
Number of GP practices served
Average number of GP practices within a PCG	19
Minimum number of GP practices within a PCG	5
Maximum number of GP practices within a PCG	66
Financial allocations
Average size of PCG financial allocation	£43.6 million
Smallest PCG financial allocation	£1.5 million
Largest PCG financial allocation	£127 million
Smallest management budget for a PCG	£119,000
Largest management budget for a PCG	£1.28 million
The PCG population and its four levels
PCGs established in April 1999	481
PCGs from April 1999 at Level 1	82 (17% of PCG total)
PCGs from April 1999 at Level 2	399 (83% of PCG total)
PCGs who will become PCTs in April 2000	17
PCGs who will become PCTs in October 2000	40 approximately

Sources: DoH (1997), Audit Commission (1999 and 2000) and Kent and Kumar (1999).

It was not until the passage of the Health Act 1999 that legislation was in place for PCGs to pursue the more radical levels of 3 and 4 which give Primary Care Trust (PCT) status. There will be 17 PCTs in England from April 2000 and more to follow in October 2000. The membership for PCTs (PCG levels 3 and 4) is different to that of PCGs levels 1 and 2. There have been comparisons made between level 4 PCTs and US Health Maintenance Organisations (HMOs), which both have the hybrid role of providing and commissioning services (Devlin and Smith, 1999).

Understanding Collaborative Organisations – the Literature

There is an established conceptual base in the literature, which provides frameworks to analyse the formulation, development and impact of such collaborative organisations (Schon, 1971; Gray, 1989; Kanter, 1994; Hudson, 1999; Meads, 1999; Pratt et al., 1999). This conceptual base can be linked to a range of general literature domains, for example leadership, effective teams (Hackman, 1990; Katzenbach and Smith, 1993), organisational design with reference to hybrid organisations (Mintzberg, 1983), public sector management (Hood, 1991; Ferlie et al., 1996), systems theory (Checkland, 1990) and, particularly, whole systems theory (Morgan, 1997; Pratt et al., 1998).

Also of relevance here is the literature surrounding health policy within primary care and, specifically, the effectiveness of the primary health care team (West and Slater, 1996; Poulton and West, 1997) and primary care purchasing (Le Grand et al., 1998), the latter predating the advent of PCGs.

The main issues from this literature are the recognition of hybrid organisational forms and the awareness that these hybrid forms are under-researched, especially in the UK health sector. This literature review also highlights that multi-agency alliances need for facilitative leadership.

Evaluating the Existing PCG Literature

PCGs are a recent policy initiative and so limited research is available. Research already undertaken includes literature reviews, surveys, case studies and multi-method studies and there is also a considerable range of commentary by practitioners and academics. Table 1.4 summarises these studies and categorises them according to their macro (i.e. national, e.g. Marks and Hunter, 1998), meso (i.e. Health Authority, e.g. Regen et al., 1999) or micro focus (i.e. within the PCG, e.g. Wilson et al., 1998).

Research Method

The research programme is a longitudinal study spanning April 1999 to April 2002.

Phase 1

Establishing teams – 1999...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of Figures
• List of Tables and Boxes
• Acknowledgements
• Editors ’Preface
• SECTION ONE: INVOLVEMENT AND PARTNERSHIP ARRANGEMENTS
• SECTION TWO: TEAMS AND INTERDISCIPLINARY WORKING
• SECTION THREE: LEADERSHIP
• SECTION FOUR: FUTURE TRENDS IN DEVELOPMENT
• List of Contributors