Primary Care Trusts

Abstract

The role of boards in the public sector is unclear, particularly at a time of increased control of services by central government. This paper looks at the case of primary health care organizations, which are responsible for providing or commissioning the health care required by their local populations. Documentary analysis of board papers from 15 such organizations showed that boards are more likely to discuss `second order' functions (finance, governance, administration) than clinical and service issues. In general, they appear to avoid a challenging style in their relationships with officers. Interviews with officers and board members of three organizations found that the possibility that boards might challenge did affect how business is conducted, even though in reality challenge was rare. However, the contribution of boards outside board meetings was also valued, in the work of subcommittees, strategy planning sessions, etc. Though the boards are in no sense representative and their importance in setting strategy and monitoring performance somewhat overshadowed by central government's activity in these areas, they nevertheless do have some authority, which both checks and supports officers.