THE LEEDS PRIMARY CARE TRUST
1
Foreword by the Chief Executive
Leeds Primary Care Trust (PCT) was formed on 1 st October 2006, replacing Leeds
North West PCT, Leeds West PCT, Leeds North East PCT, East Leeds PCT and
South Leeds PCT. The new PCT serves a population of 720,000 making it one of
the largest PCTs in the country.
As Chief Executive of the PCT I very much look forward to working with colleagues
within the organisation and with local people, clinicians and other partners over the
coming months. I want to make sure that we build on the many achievements of the
former PCTs and the service developments and improvements they put in place. At
the same time I want us to make the most of the opportunities presented by our large
size.
These opportunities include the PCT’s large staff group, who every day provide
services to the population right across the city, in people’s homes, in hospitals, in
primary care and in the community. These services are key to maintaining and
improving the lives of the people we serve. We need to support our staff in their vital
work, and together continue to develop new ways of delivering our services that
match the changing needs of our diverse and vibrant city and bring still greater
benefit to individuals and families.
The annual budget of the new PCT will exceed £1 billion. This will help us to get the
best deal for people in commissioning, organising and buying services and supplies.
And having a single PCT operating within the city makes us better able to integrate
our services with those operated by Leeds City Council and the many other
organisations working on a city-wide basis.
The merger of the five former PCTs into one represents a major exercise in
managing organisational change. The new PCT will need a structure through which
it can meet the challenges and make the most of the opportunities which lie ahead.
In common with other PCTs, we will also need to deliver a 15% saving in
management and administration costs. I want us to get on with the task of building
the new organisation quickly and in a fair and equitable way, so that all staff affected
can focus fully on our core purpose. Throughout this process, I will do all that I can
to avoid compulsory redundancies.
This paper provides a short introduction to Leeds Primary Care Trust. It outlines the
role of the PCT, the national and local context in which it will begin its work, and
some of the key issues we will need to tackle over the next six months. Against this
background, it then sets out proposals for the roles of the Executive Team of the new
organisation.
It will take a little time for the full Board of the new PCT to be appointed and to
reflect, in discussion with partners, on the way forward. It would not be appropriate,
ahead of this period of dialogue and reflection, to set out the values which will guide
our work, or a detailed strategy or work programme for the new organisation. But
what is clear is that we need to create an organisation which is responsive,
professional and focused on excellence, efficiency and innovation. Our work must
be underpinned by some key principles which we must demonstrate throughout the
PCT and in our relationships with the public and other organisations. These include:
 a clear conviction that the public requires and deserves the best – and that
there are always ways of improving what we do
 determination to engage with patients and the public as an integral aspect of
our work
 maximising the involvement of clinicians in the development of our service
 demonstrating integrity and loyalty to each other
 developing talent and leadership at every level of our organisation
 a recognition that we can always achieve much more through working
collaboratively with our key partners.
Christine Outram
Chief Executive, Leeds PCT
2
The role of the Primary Care Trust
All Primary Care Trusts have been given responsibility by the Department of Health
for three main functions. These are:
 To engage with local people to improve health and wellbeing.
 To commission a comprehensive and equitable range of high quality, responsive
and efficient services within allocated resources.
 To directly provide high quality, responsive and efficient services where this gives
best value.
The way PCTs deliver these functions is changing as part of the Government’s drive
to introduce a patient-led NHS. Important aspects of these changes include:
 More choice and a much stronger voice for patients, in consultation with their
clinicians, to choose the highest quality of care appropriate to their needs.
 A new system of practice-based commissioning, through which PCTs will work
with local practices to get the best value within available resources – drawing on
knowledge of local communities and extensive patient and public involvement.
 Commissioners working to improve the health of their population, reduce health
inequalities, guarantee choice and secure the best possible services.
 An NHS that works in partnership with local authorities and other local services to
deliver improvements and to promote equality, inclusion and respect.
 More freedom for providers to innovate and improve services in response to the
needs and decisions of patients, GPs and commissioners. Further expansion of
NHS Foundation Trusts; a continuing role for PCT direct provision; more
2
opportunities for voluntary sector, social enterprise and private sector providers
where they can help deliver better services with better value for money.
3
The Leeds context – improving health and improving services
It is impossible to describe in a few short paragraphs the complex local context in
which Leeds PCT will be working. Instead, this section gives a very brief overview of
the challenge facing the PCT as we seek to improve health, reduce health
inequalities and improve services.
Improving health and reducing health inequalities
Leeds is a successful and prosperous city which has transformed itself over recent
years. Overall the health of local people is improving. However, Leeds still faces the
challenge common to all major cities of narrowing the gap between wealthy, thriving
areas and those parts of the city which still suffer from severe deprivation.
Approximately one-fifth of the Leeds population lives in areas which are officially
rated as among the most deprived in the country. This results in, amongst other
things, significantly greater levels of ill health. Life expectancy between affluent
outlying areas of Leeds and deprived inner city communities varies by as much as
nine and a half years.
The burden of ill health also falls unevenly across communities with increased
prevalence of heart disease, respiratory disease and other health problems in the
most deprived parts of the city.
Leeds PCT will work to improve health and tackle health inequalities, narrowing the
gap between the least and most healthy in a way that can be clearly measured.
Improving services
There are many examples of high quality health services in Leeds. These span the
full spectrum from health promotion and illness prevention, through primary and
community health services, to hospital care including highly specialised services.
However, the way in which services have developed has sometimes meant that best
practice has stayed local – services across the city have not always been brought up
to the standard of the best.
Health services in Leeds also face problems which have built up over many decades
- including over-reliance on hospital care and under-developed community services,
non-integrated health and social care, inefficient and out-of-date facilities and some
major gaps in provision such as the lack of a children’s hospital.
A local health service where prevention and treatment are out of balance and where
community and hospital-based services are out of balance is reflected in difficulties
achieving financial balance. The financial challenges facing the Leeds health
economy can only be solved by both redesigning services and ensuring that services
are efficient.
3
Health organisations in Leeds have been working hard over recent years to address
these challenges. The Making Leeds Better programme provides a mechanism for
tackling many of these issues but the most difficult challenges of delivering Making
Leeds Better – transforming the way in which healthcare is delivered in hospitals and
closer to people’s homes – are still to come.
Leeds PCT will work to ensure that plans for improved services are delivered in a
way which gives everyone in Leeds equal access to high quality, responsive and
efficient health services.
4
What will Leeds PCT be about?
We will make sure we take the opportunity, over the coming months, to develop the
core values, key objectives and ways of working that will mark our work. There are
three key overriding ambitions which it is clear at this stage that we will want to be
known for:
 Working in close partnership with Trusts, primary care clinicians and Social
Services, we will focus on achieving a real transformation of the health care we
secure for the people of Leeds, delivering a step change in the quality of services.
We will stay well ahead of, rather than struggle to meet, national quality targets
and standards.
 Working as part of a strong and focused partnership with the local authority, third
sector, local business and the people of Leeds, we will focus on improving public
health and wellbeing and achieving real and demonstrable reductions in health
inequalities.
 As one of the largest PCTs, in one of the UK’s major cities and most complex
health economies, we have every opportunity to become a leading national
player. We will rise to this challenge, and become known for the quality of our
organisation and our results, and the changes and improvements that we deliver.
5
Focus for the next six months
The following three areas will provide a focus for the initial work of the PCT through
to the end of 2006/07.
Vision and strategy
We will bring people together to develop in more detail the strategic direction and
sense of purpose for Leeds Primary Care Trust. In doing this, we will look to build on
existing achievements including the Making Leeds Better programme and the work
of the five former PCTs. We will also make sure we develop our strategy with our
partners and within the context of the Vision for Leeds and supporting plans
including the Local Area Agreement, the Health and Wellbeing Plan and the Leeds
Regeneration Plan. We will develop our outline strategy by the end of December.
An important priority will be to develop ways of working with practice based
commissioners, getting the right links between their priorities and issues and the
direction we are setting on a wider scale through Making Leeds Better.
4
Organisational change
The merger of the five PCTs means that we face a major programme of
organisational change which must be well managed. We will set out a clear
timetable and process for that change, ensuring that staff are kept fully informed and
involved.
An early priority will be to recruit a first class team with the right blend of skills and
personalities to work within the context of PCT’s underpinning values and
distinguishing features. Having identified the Director-level posts needed within the
new PCT (these are attached as Annex A) we will aim for completion of Director
appointments by the end of November.
We will establish an interim Professional Executive Committee (PEC) to take us
through until April 2007 when new national guidance on PECs and clinical
engagement will have been published.
We will develop a plan for a single main headquarters building for the PCT. Although
some multi-site working is likely to continue, we will, as a minimum, bring the core
management and commissioning functions of the PCT together under one roof.
Keeping everyone informed about our progress in developing the new organisation is
very important. We will arrange a series of staff meetings and briefings through
October to inform colleagues about the new PCT and provide an opportunity for staff
to share their views, ask questions and flag up any concerns.
Success in our current business
It is essential that we remain focused on our core business even while the
organisation is changing. We have put interim management arrangements in place
to ensure that the new PCT is able to work effectively from day one and that staff
and partners know who is leading on particular issues. These arrangements are
summarised at Annex B.
Over the next six months we will all need to work hard to deliver successfully on our
national and local priorities for service improvement. An important current concern is
to ensure that the financial position of the new PCT is under control and managed
effectively over the remainder of the current financial year.
6
Director Portfolios for Leeds PCT
An organisation chart outlining Director portfolios is attached at Annex A. The
following section outlines the approach taken to the PCT’s key responsibilities
around strategy, commissioning and service development. There is then a brief
description of the core purpose of each of the Director posts so far identified,
together with an outline of some of the issues which require further consideration and
may result in additional posts being identified or in adjustment of portfolios.
Approach to strategy, commissioning and service development
A large part of the PCT’s purpose is to commission present and future health
services of high quality that offer value for money. It is extremely important that over
5
the next few years we start to put in place the strategic transformation in services
through the vision being developed by the Making Leeds Better programme and in
other key service areas such as Mental Health and Learning Disabilities. It is equally
important that we work with practice based commissioners and enable them to
deliver meaningful change for people now, and work with Trusts, Social Services and
other providers to offer improved, better integrated and more efficient services. This
is a huge agenda, and two Executive Director posts are proposed to lead it. They
will clearly need to work closely in tandem, agree priorities for service development
and improvement, work out how shorter term commissioning will support the longer
term strategic agenda. Both will be engaged in service improvement and the
development of new and better care pathways for patients.
In addition to the two Executive Director posts, a post of Director of Planning and
Commissioning for Children’s and Maternity Services will be established. The
inclusion of this senior post reflects the importance of Children’s and Maternity
Services as a major focus within the Making Leeds Better programme and, alongside
this, the development of Children’s Trust arrangements, led by the City Council, to
improve the full range of services for children and young people and their families
and carers.
The Director of Planning and Commissioning for Children’s and Maternity Services
will be a joint appointment, reporting to the PCT’s Executive Director of
Commissioning and to the City Council’s Director of Children’s Services.
Executive Director of Commissioning
The purpose of this post will be to develop and drive the PCT’s commissioning
strategy, planning and implementation over a one to two year time horizon. The
Director will be responsible for shaping the supplier market, determining
commissioning priorities, securing high quality services and performance managing
providers through contracts (including primary care and the PCT’s own provider
services). It will develop, empower, support and coordinate practice based
commissioners and ensure that the vision and aspirations of primary care clinicians
for service improvement are reflected and met through the delivery of services
commissioned. The Director will also have overall responsibility for ensuring the
clinical governance and clinical quality of commissioned services.
Executive Director of Strategic Development
The purpose of this post will be to direct, drive and implement the PCT’s longer term
strategy, in order to bring about major strategic change in the way that health care is
provided, including changing the boundaries between hospitals and services in
primary care and the community. It will harness the impetus already existing within
the Making Leeds Better programme, and the Director will provide leadership for the
further development of that programme. The role will include:
 The development of new care pathways to improve patient care: redressing the
balance between hospital services and community services and increasing the
emphasis on prevention of ill health and earlier intervention and support for
patients with long term conditions.
 Development of a long term capital programme to support delivery of the PCT’s
service strategy, including the use of LIFT arrangements and other capital
developments in primary and community services.
6
 Working with Leeds Teaching Hospitals Trust on the development of PFI
proposals to support the delivery of Making Leeds Better, including a new
Children’s and Maternity Hospital.
 Development of programmes to transform other key services, including Mental
Health and Learning Disabilities.
Executive Director of Public Health
The Executive Director of Public Health will have overall responsibility for improving
and protecting the health of the population and reducing health inequalities. The
postholder will need to work closely with Leeds City Council, the voluntary and
community sector, local business networks and others, particularly through the
Leeds Initiative as the Local Strategic Partnership for the city.
Although the Director of Public Health will be a PCT appointment in the first instance,
the PCT and Leeds City Council have agreed to work towards a joint appointment. A
memorandum of understanding between the PCT and the City Council will set the
context for the appointment of the Executive Director of Public Health for whom an
early priority will be to draw up proposals for moving to a joint appointment.
A key feature of this role will be to contribute to the development of Local Area
Agreements to improve health and address health inequalities. Equally important will
be to ensure strong public health support to the PCT’s Commissioning and Strategic
Development functions, including an understanding of population health needs and
ensuring that commissioned services reflect the best available evidence of clinical
effectiveness.
The postholder will also work closely with the Director of
Communications and Corporate Affairs to realise the concept outlined in the Wanless
report of “fully engaged citizens”.
Executive Director of Care Services
The Executive Director of Care Services will have overall responsibility for ensuring
high quality, responsive and efficient directly provided services for both adults and
children. S/he will be responsible for clinical governance and patient safety of all
these services and for ensuring the professional leadership and development of staff
working in them; also for the utilisation of PCT estates and assets.
A key feature of this role will be to ensure that directly provided services are able to
transform to support the choices exercised by patients and practice based
commissioners, and to support the major shifts from secondary to primary care being
envisioned through the Making Leeds Better programme. At the same time the
postholder will need to agree with staff and the PCT Board the best organisational
model for the longer term, including consideration of social enterprise and/or the
development of a Community Foundation Trust.
Executive Director of Finance and Investment
The Director of Finance will have overall responsibility across the commissioning and
provider functions for financial control, financial performance, financial strategy and
financial governance. This is a key central post in the PCT, which will only be able to
make a real difference to health and health care in Leeds from the foundation of a
stable financial platform. The postholder will also need to ensure strong financial
planning input to the development of the Making Leeds Better strategy, and effective
grip as we move to implement the strategy over the next few years.
7
Director of Workforce
The Director of Workforce will lead the HR function of the PCT and also provide
workforce expertise to the strategic development and commissioning roles of the
organisation. Consideration has been given to the HR portfolio being accountable to
the Executive Director of Care Services. However, given the major organisational
change that the integration of the five former PCTs in Leeds represents, it is clear
that the Board will benefit from HR, change management and organisational
development expertise being available at Board level. The Director of Workforce will
therefore report directly to the Chief Executive in the first instance, subject to a
review after the first twelve months to identify where the post should fit within the
PCT’s management structure in the longer term.
Director of Communications and Corporate Affairs
The new PCT will play a large and powerful role within Leeds. We need to be able to
have a real dialogue with the local community if we are to be a good advocate for
people and patients. If we are to secure real transformation of local health and
health care, the PCT will need to demonstrate far more than ever before that it
understands the needs and wishes of the population. We will need to facilitate
choice for patients and square those choices within a clear and transparent strategic
framework.
The Director of Communications and Corporate Affairs will manage the development
of the public involvement agenda, drive communications and provide support for the
PCT’s strategic relationships with key partners. The post holder will ensure an
effective service to other key Directors in this, including support for the
Commissioning Director on choice and operational planning, support for the Strategic
Development Director on the major service transformation being planned through
Making Leeds Better, and support for the Director of Public Health on ensuring a
strong interface with the public in order to promote the Wanless concept of ‘fully
engaged citizen’.
In addition, this post will be responsible for ensuring sound integrated governance
across the PCT, and provide support for the Chairman and the Board.
Chief Information Officer
The inclusion of a board-level Chief Information Officer within the PCT structure
reflects the importance of health informatics to the work of the PCT, both in terms of
infrastructure development and availability of high quality information to support
commissioning, performance management and service provision.
The postholder will be responsible for delivery of the National Programme for IT
across the PCT, working closely with NHS Connecting for Health, ensuring sound
information governance arrangements are in place and establishing information
management and technology as a key enabler of and integral to the PCT’s strategies
and business plan.
8
Issues requiring further consideration
The Director portfolios outlined above represent an initial structure to enable the PCT
to move ahead with the establishment of its senior management team. There are a
number of key issues which it is important for the new PCT to reflect upon in more
depth. These include:
 How the PCT will ensure that it is able to work effectively both at a local level and
across the city as a whole.
 How to ensure that nursing and medical leadership are appropriate, effective and
correctly positioned within the PCT’s structure.
 Where to locate leadership for primary care development within the Director
portfolios
These issues are outlined in more detail below:
Approach to localities
The scale of the PCT and the fact that it is coterminous with Leeds City Council
provide major opportunities for the new organisation. These include the scope to
provide clear and consistent leadership for service improvement and commissioning,
bringing together scarce expertise and avoiding duplication, improving coordination
with social services and working more effectively at a city-wide level with the local
authority and Leeds Initiative partners through mechanisms such as the Local Area
Agreement.
However, it is also essential to retain the ability to work at a local as well as city-wide
level and the new organisation must never allow itself to become ‘remote’. Key
issues requiring a local focus include:
 Partnership working, particularly involvement in District Partnerships and links
with Area Committees, including a strong focus on health improvement
 Commissioning local services
 Providing community and primary care services
The structure and processes established for the PCT will need to take into account
the need to support local working. Different issues may need different approaches
and it is important to ensure that locality arrangements are appropriate and effective.
Possible approaches include:
 A Director of the new PCT is given overall responsibility for locality working,
supported by nominated senior managers with responsibility for particular
localities.
 PCT Directors each take responsibility for a “wedge” alongside their portfolio and
with support from nominated senior managers.
Either of these options could be supplemented by the identification of a lead NonExecutive Director for each wedge.
Because of the importance of these issues, we will take the time needed to listen to a
range of views and work up the right approach. Once an approach has been
agreed, it will be implemented either by amending relevant Director portfolios and/or
through the establishment of new key posts. In the meantime, the interim
management arrangements, as outlined at Annex B, will ensure that a locality focus
is maintained while longer term arrangements are being developed.
9
Nursing and medical leadership
Nursing and medical leadership are central to the success of the PCT and it is vital,
within a changing context involving the development of practice-based
commissioning and a clearer distinction between the PCT’s commissioning and
provider functions, that this issue is given careful consideration to ensure that
leadership is appropriate, effective and correctly positioned within the PCT’s
structure.
Because of the need to identify the best approach to this, the initial round of Director
appointments will not include either a Chief Nurse/Director of Nursing or a Medical
Director. Once the initial appointments have been made, the Management Team will
reflect, in discussion with nursing and medical colleagues, on how best to deliver
nursing and medical leadership either through the establishment of additional roles
or incorporation within existing portfolios should suitably qualified and experienced
candidates be selected in the first round of appointments.
Primary Care Development
Primary care provides the foundation for an effective and responsive health service
and, together with community health services, is critical to the delivery of Making
Leeds Better. There are several potential ways to build primary care development
into the Director portfolios of the PCT including within the portfolio of the Director of
Commissioning or as part of the role of the Director of Care Services. This issue will
be given further consideration once the initial Director appointments have been
made. This will ensure that the background and experience of the individual
postholders is taken into account when identifying how primary care development
can be given the best possible leadership within the new PCT.
7
Next steps
The immediate next steps in taking forward the development of the new PCT
management arrangements will be:
 To advertise the initial range of Director posts
 Appointment of successful candidates
 Newly appointed Directors will work with the Chief Executive to develop plans for
the structures needed to deliver their portfolios, within agreed budgets
 The Management Team, together with relevant colleagues and partners, will work
to identify the way forward in relation to the issues for further consideration
outlined in section 6.
10
Annex A
Organisation Chart: Initial Director-level posts
Chief Executive
Executive Director of
Finance and
Investment
Executive Director of
Public Health
Executive Director of
Commissioning
Executive Director of
Strategic
Development
Executive Director of
Care Services
Director of Planning
& Commissioning for
Children’s &
Maternity Services
11
Director of
Workforce
Director of
Communications
and Corporate
Affairs
Chief Information
Officer