It’s great that primary care trusts have been busy rebranding. My local PCT has now become NHS Suffolk, which is slightly more likely to mean something to people.

Let’s face it, the concept of a primary care trust didn’t. Few outside the NHS can explain the difference between primary and secondary care. If you don’t believe me, the next time you are on a bus or train, ask the person nearest you whether a brain surgeon works in primary or secondary care.

World-class commissioning, or emplying the bins?
If you’re not into talking to strangers, the next best thing is to download a copy of Who’s Accountable for Health? (http://www.lga.gov.uk/lga/aio/721828). This is a report published last October by the Local Government Association.

An opinion poll carried out for the report’s authors found that 71 per cent could not name their local PCT, and when asked what PCTs did, the fourth most popular answer amongst those who said they knew was ‘empty the bins’.

So with a fairly low level of general awareness, it’s not surprising that the development of an internal market in the provision of health services (in England at least) has gone over most people’s heads.

So what do patients think when they access services that are provided by a plethora of competing organisations - all in the name of the NHS? The provider could be a foundation trust; a private company providing out-of-hours services; or a GP practice.

All will have valid reasons for wanting to communicate with their customer. They may want to drum up business for a new service; highlight changes to existing services; or simply apologise for getting something wrong.

Who owns Brand NHS?
But what about the NHS brand? You might argue that it’s not really in any danger. It may be that many people - perhaps most - cannot make the distinction between providers of health services: the only thing that really matters is that patients are treated fairly, quickly and are satisfied with the outcome.

So what happens when foundation trust A starts telling not just local people about its wonderful performance, but getting the message out to those who live in areas typically served by foundation trust B (which may not have performed so well)? The NHS brand is going to take a bash.

As the chief executive of a fledgling foundation trust, the Royal Marsden’s Cally Palmer must have had this in mind when she raised the question of what she could say to promote the Marsden in an NHS of patient choice with then-NHS chief executive Sir Nigel Crisp. Palmer described this scenario at an HSJ marketing conference in 2006.

Crisp reportedly told her that she could say anything she could prove, so long as it didn’t denigrate another NHS trust.

This strongly implied that the NHS brand was in the care of the Department of Health. It took the Department several years of deliberation to come up with a set of guidelines, but in March 2008, a promotion code was published.

The code takes care of back-of-the-bus advertising and misleading leaflets. However, determined providers will always find ways of promoting their services and denigrating their competitors.

Take PR, which is an important part of the marketing mix. Who is going to stop the communications director at a hospital briefing local journalists against a competitor, or GP practices? In fact it’s already –sometimes - happening. When such stories eventually appear in local newspapers, what do customers make of a health service that is supposedly united under one brand?

The wake-up bomb
A code might prevent overt posturing, but it only goes so far. With the direction of travel of NHS reform taking us inevitably into a freer market, the temptation to sidestep traditional advertising and use other means of promotion will grow.

So the Department needs to wake up and get to grips with protecting a brand that is being eaten away. It can be done, and now is the time to do it.

Julian Tyndale-Biscoe is a former journalist and editor, and is managing director and founder of InHealth Communications (www.inhealthcomms.com).