аЯрЁБс>ўџ 02ўџџџ/џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅС[@ №Пbjbj44 .*ViViПVџџџџџџˆЊЊЊЊЊЊЊО8:NО іnnnnnnnnК М М М М М М R_^М ЊВnnВВМ ЊЊnnб h h h ВњЊnЊnК h ВК h h z ЊЊz nb @~`™€ЧЌ vz К ч 0 z Н" шНz ООЊЊЊЊНЊz @nцTЄh ј„|6nnnМ М ООD ^ОО This guidance from the DH sets out new arrangements for the PCT Professional Executive Committee (PEC). PCTs now have the freedom to determine how PECs should be structured and operated according to local circumstances, based on a set of guiding principles for all PCTs who are required to implement the recommendations by October 1st this year. The document is unsigned but the foreword is by Mr Andrew “Andy” Burnham who is the Minister of State of Health for Delivery & Reform. He “firmly believes” that successful clinical leadership is “paramount if we are to deliver health reform.” Clinicians need a much bigger role because encouragingly for a New Labour minister he thinks that “they know what patients want and how to deliver it.” He says that he also believes that this guidance presents an opportunity to “develop clinicians across all sectors to become drivers…” by which he does not mean moonlighting in taxis after Modernising Medical Careers but rather as “leaders of clinical change.” Or delivery drivers, perhaps? The document is, as sharp-eyed readers will have spotted, written in that curious style unique to the DH and unknown in the real world. Does anyone really speak like this at home? PECs need to change because the NHS is changing and in particular the introduction of Practice Based Commissioning (PBC) will require strong clinical leadership, delegation of budgets and commissioning decisions made by clinicians. Because of the diversity of PCTs a new principle is flexibility for PCTs to decide how their PECs should operate whilst striking a balance with core principles common to all. PECs are seen as “important in supporting the development of a vision and strategic direction for the PCT” – one imagines one of those enormous Chinese Communist paintings where unity and harmony bind handsome factory workers and buxom milk maids as they gaze certainly into the broad, sunlit uplands – PBC will in fact be the main mechanism by which front line innovation and service reconfiguration are delivered. PECs and PBC will then represent two different but mutually supportive parts of clinical engagement and leadership that will be vital for commissioning high quality services. PECs will set the “overarching framework, direction and environment for PBC and link PBC to the PCT’s overarching commissioning strategy. Moreover, PECs will be expected to realise the full potential of the “Three at the Centre” management doctrine. The mystic triangle of accountability, leadership and management will be shared by the PCT chairman, the PCT chief executive and the PEC chairman. Let’s hope that “Three at the Centre” will not translate into “Two’s company…” PECs will, of course, be patient-focussed, promote health and well-being of communities and address health inequalities, be drivers of strong clinical leadership and enablers of clinical empowerment (or empowerers of clinical enablement), be expected to reflect a range of clinical professions and their wealth of experience. After all, we know that “where change has been successful, senior, visible clinical leadership to drive through those changes in partnership with good management has been the critical success factor.” PCTs will have the freedom to determine how PECs operate according to “local circumstances.” This will be especially true in PBC where, should local development be immature, the support of the PEC will be invaluable in offering nurturing support, rather than direction, and then gradually withdrawing as the first hesitant steps become more confident. In Somerset, of course, the reverse may be the case. PCTs will have to have a PBC approvals committee and, of course, clinicians who might benefit financially will have to declare an interest and withdraw from decision-making. Transparency, pragmatism and good old British common sense should manage conflicts of interest. Exact PEC membership is therefore for local determination but the commonest number suggested during the consultation was eight. Account should be taken of including one or more PCT board directors – there will be eight of these in Somerset – professional members should be practising, “carrying a caseload” and form a majority. Others, such as PCB consortia leads, secondary care clinicians, and patient representatives might be co-opted where particular pieces of work require their skills. The chairman should sit on the PCT board as part of the triumvirate. As far as how to choose members the DH recommends appointment by interview “against defined roles set out in a job description.” Members should not be chosen to represent their profession but as office holders to be appraised annually, supported by a PDP to assist him or her in her delivery of objectives. Specification and competencies are given in an annex and both are full of abstractions like being full of “leadership,” “support,” “championing,” “innovation” and “fill in the rest here.” Term of appointment should be for local determination, perhaps allowing PEC members to stay on until they wish to “take on another leadership role, stand down or their performance is judged substandard (as in any other NHS management/leadership role)” (my italics). Remuneration will also be subject to flexibility but further guidance is promised. Finally, potential PEC chairmen should undergo “a rigorous assessment and interview” to ensure competence. There may be a panel of three or four, reflecting the “Tres in uno” lead group structure, for instance, the PCT CEO, the chairman and, for the first appointment a former PEC chairman from a preconfigured PCT and/or another professional representative with “relevant experience.” It does not say anything about LMC chairmen but further advice can be sought from the Appointments Commission on 0870 240 3801.     Primary Care Trust Professional Executive Committees Fit for the Future M O y А  П Щ Ь  Р С Ј Љ YZkŠ‹ŒЇ…†•–ъы+EFGџ89ТЭ$jk'UЭ\gѕћЛОіютюкюкюкювювквквкЪкЪкТвТвТКТКВКВКвКкКЊКЊКЊžЊв’в†вЊhяE%hяE%5OJQJhяE%hяE%6OJQJhЮKhЮK6OJQJhЮKOJQJh&QёOJQJhы OJQJhѓ=ўOJQJhZOJQJhяE%OJQJhќЈOJQJh{Nљh{NљH*OJQJh{NљOJQJhњ}Q5OJQJ3Р С YZ3…†•–+9:kl[\ЙКМПСТФХЧШЪїїїїїїїїїїїїїїїїїїїїїѕѕѕѕѕѕѕ$a$gd№=ђП§§ОПРТУХЦШЩЫѕэщэщэщэщйЭЩщѕh&Qёh{Nљh&Qё5OJQJh{Nљh&Qё5CJOJQJaJhљ2‘jhљ2‘Uh{NљhЮKOJQJЪЫ§јј§§№$a$gd№=ђgd{Nљ,1hА‚. 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