GP practices denied millions of pounds in premises funding (GP Online: 15 June 2015) 

Councils across England are using planning powers to take millions of pounds from developers to help fund GP infrastructure. 

But lack of integration between NHS bodies and councils could mean valuable potential funding is not reaching practices that need it.

Analysis by GPonline found wide gaps between local authorities in use of powers to demand contributions from developers for healthcare infrastructure. Data obtained under the Freedom of Information Act showed that of 173 councils examined in detail, 110 had not used these powers in the four years from 2010/11 to 2013/14.

Specialist healthcare premises lawyers told GPonline that weak integration and communication between councils and fragmented NHS bodies could mean potential funding was not reaching practices that need it.

Nathan East, a partner at law firm Weightmans, said local authorities' links to the NHS were often through CCGs, many of which have little involvement in premises funding.

GPC executive lead for premises Dr Brian Balmer said he would be unsurprised if the ‘impenetrable’ NHS estates system was making it difficult for councils to know how best to funnel funding into primary care infrastructure.... read more

 

Monitor angers CCGs with advice on community services (HSJ: 23 January 2015)

Commissioners have voiced concern that their efforts to integrate services will be hampered by ‘enforced competition’ after Monitor released a report warning them against simply rolling over existing community services contracts.

The regulator’s report urged clinical commissioning groups to use the end of current contracts – anticipated for many services in 2015-16 – as an opportunity to introduce new care models recommended in the NHS Five Year Forward View.

In a statement released yesterday alongside the report, Monitor said half the CCGs it spoke to with community services deals ending in 2015 planned to extend at least one of their contracts with the current provider. It warned that CCGs should not automatically roll over existing contracts.

CCGs reacted with anger, saying freedom to integrate care should not be blocked by “unnecessary enforced competition”. Catherine Davies, Monitor’s executive director of cooperation and competition, said: “We do not think that commissioners should automatically roll over community services contracts. As the [current contracting] arrangements run out they should take the opportunity to explore ways of improving the community care available to their patients. “Looking to improve services for patients does not mean necessarily putting contracts out to full competitive tender, but it may be the best option in some cases.” 

Steve Kell, co-chair of NHS Clinical Commissioners, responded: “We know from our members that CCGs are not automatically rolling over community services contracts, but are actively improving local services by finding and developing local solutions.

“The last thing we need if we are to deliver the better care fund is competition where it is not in the best interest of patients.“This report from Monitor highlights the significant gap between their rhetoric and reality, and it is essential that CCGs are allowed the freedom to deliver integrated care and that this is not prevented by unnecessary enforced competition.”... read more

 

Potential risk of private contract to Western Sussex Hospitals NHS Trust laid out in impact assessment (Health Investor: 7 January 2015)

An independent report on BupaCSH’s musculoskeletal services (MSK) contract has stated that the new service could “negatively impact” the local NHS trust.

Coastal West Sussex Clinical Commissioning Group (CCG) awarded BupaCSH a five-year, £235 million contract to deliver local MSK services in September 2014. Previously, the services were managed by Western Sussex Hospitals Foundation Trust. 

However, Coastal West Sussex CCG and the trust jointly commissioned PwC to carry out an independent assessment of the contract after the trust raised concerns about its impact on wider hospital services.

PwC’s report concluded that it could “achieve benefits” but that the “cumulative impact of loss of MSK services” could add up to £13.4 million over the five-year contract. This would result in the trust falling into deficit. This could happen “specifically if providers conduct outpatient activity but do not also provide inpatient services”. 

This news comes after Bedford Hospital NHS Trust refused to sign the contract for local MSK services awarded to Circle in November 2014 due to potential impact on the viability of the trauma service.... read more

 

NHS services in Nottingham cut after doctors quit rather than work for private firm (The Independent: 16 December 2014)

An NHS hospital has been forced to scrap highly rated services for patients with severe skin conditions, including skin cancer, after an 'exodus' of senior doctors reluctant to work for a private sector subcontractor. 

Nottingham University Hospitals Trust said it would no longer be able to provide acute adult dermatology, including emergency care, after losing six of its eight consultants.

Five of those departing are understood to have left rather than transfer to Circle, a private healthcare company which won a contract to provide most of the local dermatology services last year. The closure of the service has raised concerns about the impact of privatisation on the NHS, with doctors worried about job security in the private sector.

The trust lost out to Circle, despite warnings from senior doctors that they would leave rather than be transferred out of the NHS, the Health Service Journal reported.

It is understood that the senior doctors who left were concerned over job stability at a private employer, and also had fears that a profit-driven provider would not offer opportunities for academic research or training.... read more

 

Bedford refuses to sign Circle MSK contract (HSJ: 7 November 2014)

An NHS hospital has pledged to compete with Circle Partnership, the private provider appointed to run Bedfordshire’s £120m integrated musculoskeletal service, after refusing to become its subcontractor, HSJ can reveal.

Bedford Hospital Trust has refused to sign the contract after seeing the number of MSK referrals plunge 30 per cent after Circle took over the service in April.

The trust claims the service’s arrangement “endangers the viability” of its trauma and accident and emergency services and could undermine its capacity to retain the seven trauma surgeons it employs.

Circle was awarded the five year “prime provider” contract by Bedfordshire Clinical Commissioning Group in April. The deal consolidates 20 separate contracts into a single service and gave Circle the role of running it.

Bedford Hospital’s board papers say it “would not be in the trust’s best interests to sign a contract without any mitigation to the consequent impact on trauma and linked services”.

“The significant reduction in referrals since April, and associated potential loss of income (assuming these convert to elective work) mean a direct impact on the viability of the trauma service which in turn will undermine the ability of A&E to see and admit trauma patients,” they say.

Trust chief executive Stephen Conroy told HSJ there was now a risk its income from MSK would no longer support its contingent of consultant surgeons.

“At some point at the future that would mean the service would either lose a lot of money or become non-viable,” he said. “We’ve got enough need to keep us going until the end of next financial year [but] it remains an open risk for next year.”

Bedford has requested a minimum income guarantee for 2014-15 to cross subsidise the trauma service. This was declined by the CCG and Circle on the grounds it would limit patient choice.

 

London spending on private ambulances 'grows tenfold' (BBC News: 22 October 2014)

Spending on private ambulances in London grew by 1,000% between 2011 and 2013, the Labour party has claimed.

The NHS spent £8.84m on private ambulances in the capital last year compared to £795,000 in 2011, according to Freedom of Information data. The London Ambulance Service (LAS) conceded it was losing staff due to "pressure on the organisation". But LAS denied claims it had employed private staff previously sacked by the NHS

 

West Sussex plea to review A&E threat contract (BBC News: 16 September 2014)

The medical director at the Western Sussex Hospitals NHS Trust has raised serious concerns about the future of emergency care at the organisation as a result of the trust losing the contract to provide local musculoskeletal services to Bupa. Dr George Finlay is concerned that “this move may affect our ability to provide that emergency care."

He said trauma services relied on a significant number of highly-trained surgeons and added: "If you take the elective bit out and 'cherry-pick' parts of it, that may leave us with an unsustainable rota and not able to provide trauma services on two sites. The knock-on effects are then quite potentially significant - can we support two emergency departments and A&E departments on both sites?"

 

Cancer care commissioning is in chaos since NHS reorganisation, says leading charity (BMJ: 8 September 2014)

The government’s reorganisation of the NHS in England has caused chaos in the commissioning of cancer care services, which now needs radical change to be made fit for purpose, says a report from Cancer Research UK.

The charity said that confused structures, unclear accountability, and loss of national oversight, combined with insufficient funding, threatened to reverse hard won gains in survival rates among people with cancer. Harpal Kumar, the charity’s chief executive, said that cancer services were now at a “tipping point,” with staff fighting to keep them viable in a context of flatlined budgets and rising demand from patients. 

The report looked at the current state of cancer services, 18 months since NHS reorganisation came into force under the Health and Social Care Act. The charity commissioned Birmingham University’s Health Services Management Centre to conduct interviews and surveys among clinicians, commissioners, GPs, experts in public health, and patients...read more

 

NHS plans rapid expansion of 'doctor's assistant' jobs (BBC News: 22 August 2014)

The NHS is to rapidly expand the number of people in "doctor's assistant" roles.

Physician associates are usually science graduates who have two years of intense training.

However, some concern has been raised that the more junior posts will be used to replace more expensive doctors, damaging care.

The Department of Health said physician associates allow busy doctors to spend more time with patients.

The assistants have been working in the NHS for the past decade and around 200 are employed at the moment.

Many have previously worked as nurses or paramedics. They can take a patient's history, make a simple diagnosis or do an examination, but cannot prescribe drugs, order X-rays or work without doctor supervision.

 

Income from private patients soars at NHS hospital trusts (The Guardian: 19 August 2014)

Some of Britain's leading hospitals stand accused of exploiting the coalition's controversial lifting of the cap on the number of private patients they can treat to increase their income as part of a "creeping privatisation" of the NHS.

As new figures show that some hospitals have seen a big increase of up to 40% in their private income since the cap was lifted, Labour accused ministers of presiding over a scandal of declining standards for NHS patients while allowing paying patients to enjoy high standards of care.

The determination of NHS trusts to make the most of the cap being lifted has been highlighted by the decision of the Royal Brompton Trust, a centre of expertise in treating heart and lung disease, to open a "private outpatient facility" in Harley Street, the world centre of private medical treatment. But less than a mile away from the Brompton Hospital, at the Chelsea and Westminster Hospital on the Fulham Road, west London, there is concern about the implementation of the lifting of the private patient cap. Its annual report lists it as one of the "principal risks and uncertainties facing the trust".

 

Plans to overhaul west London hospitals approved (BBC News: 30 July 2014)

More than half of Charing Cross Hospital will be sold after plans to overhaul health services in west London were approved.

At a board meeting, the Imperial Healthcare NHS Trust voted through the plans to sell 55% of the site.

Units including neurosurgery, stroke and urology will also "move out" of the hospital.

The trust said there were no plans to close the A&E department, but opponents believe it will be downgraded.

In relation to the A&E, Imperial Healthcare NHS Trust said it was waiting for "further guidance from NHS England to guide the development of emergency services appropriate for a local hospital".

 

Pharmacies demand to be 'first point of contact' for overstretched NHS (The Independent: 17 July 2014)

Pharmacies and high-street health specialists are “key to the survival of the NHS” and should be the “first point of contact” for tackling smoking and obesity levels, according to a coalition of leading primary healthcare experts.

The call from Pharmacy Voice, the body that represents all of Britain’s 11,500 community pharmacies, comes as a major medical think tank warns that “cracks” are showing in the NHS as it struggles to face “huge pressures” on its finances.

Many pharmacies already offer some health advice, but in a major new report backed by NHS Alliance, the Optical Confederation, and the National Community Hearing Association, Pharmacy Voice has urged for “high-street health specialists” to become the “first point of contact” for many long term conditions and minor illnesses that would traditionally be dealt with in hospital or by GPs.

 

Councils and NHS services must work together to share risks and savings (The Guardian: 10 July 2014)

Relationships across the system need to be strengthened before the Better Care Fund goes live in April 2015

The biggest ever push to integrate health and social care is in serious difficulty. What has gone wrong with the Better Care Fund and can it be fixed?

The difficulty stems from the fact that half of the basic £3.8bn fund, intended to support integration projects in 2015-16, has been stripped out of budgets for acute health services. The hospital lobby argued that this risked pushing providers further into financial difficulty. The government has responded with a clawback mechanism which will keep £1bn of it largely in the NHS and make it dependent on achieving locally agreed reductions in hospital admissions.

In response, David Sparks, in his first speech as the new Labour leader of the Local Government Association (LGA), told its annual conference on Tuesday: "We are seeing Whitehall trying to strangle [the fund] at birth."

The increasingly bitter tone of the dispute reflects the massive financial stress facing both the NHS and local government. It is akin to drowning sailors fighting over a lifebelt. But it is also a clash of cultures and perspectives.

 

Staffordshire cancer care 'could be privatised' (BBC News: 3 July 2014)

Cancer care across Staffordshire could be privatised as part of a £1.2bn contract, a trade union has warned.

In what is believed to be the biggest outsourcing deal in NHS history, four clinical commissioning groups (CCGs) are jointly tendering for a body to integrate care across the county.

The Unison trade union said it could mean the privatisation of care and described it as a "huge gamble".

The CCGs said patients' treatment would be unaffected.

Andrew Donald, chief officer for Stafford and Surrounds and Cannock Chase CCGs, said no decision had yet been made on a provider. "It could be an NHS body, it could be a voluntary body, it could be a private body or it could be all of them working together," he said.

The successful bidder will be asked to co-ordinate cancer care throughout Staffordshire - from diagnosis through to treatment and end-of-life care.

 

NHS England mulls young people's mental health tender (Health Service Journal: 11 June 2014)

NHS England is considering putting inpatient child and adolescent mental health services out to tender in a bid to tackle “out of area” placements for vulnerable young people.

The national commissioning body has confirmed to HSJ that it is considering measures to reduce the number of “long distance transfers within CAMHS”, including “any necessary tendering for services.”

It comes amid widespread concern over the specialised CAMHS services - known as tier 4 services - commissioned by NHS England.

In February, HSJ revealed that a moratorium by NHS England on commissioning new services was exacerbating a shortage of specialist mental health beds for younger people, and leading to young people being placed in facilities many miles from their homes.

 

"Appalling" service by private firm leaves NHS patients without drugs (Our NHS: 3 June 2014)

Thousands of NHS patients, some seriously ill, have not received vital medicines on time because of problems at the company contracted to deliver the drugs to these patients in their own homes.

The failures in the service offered by private contractor, Healthcare at Home, have been described by patient groups as ‘appalling’ and ‘unsafe’, and have left patients with life-threatening conditions frightened about their ability to get hold of their drugs.

After a flood of complaints the pharmacy watchdog was invited by Healthcare at Home to investigate the service and has now given the company three months to sort out its problems.

Healthcare at Home dispenses and delivers more than 1 million prescriptions annually to over 150,000 patients who are suffering from serious illnesses such as cancer, haemophilia, HIV and multiple sclerosis, or who are receiving fertility treatment or drugs following organ transplants

 

MSK procurement model could 'destabilise' local health economies (HSJ: 13 June 2014)

Clinical commissioning groups that commission elective and trauma musculoskeletal services separately risk destabilising their local health economies, the British Orthopaedic Association has warned.

The alert came from Tim Briggs, the association’s president and a consultant surgeon at the Royal National Orthopaedic Hospital Trust. He became concerned after several CCGs tendered out elective services only, leaving NHS hospitals to pick up the trauma workload.

Bedfordshire CCG recently awarded its MSK contract for elective surgery to private provider Circle, while Bexley CCG has made King’s College Hospital Foundation Trust its preferred bidder to deliver the service.

Professor Briggs said the focus on commissioning elective work risked the trauma side of MSK services being forgotten.

“We make money on tariff from elective surgery,” he added.

“The risk by splitting the two [is that] you’re still asking the local NHS trust to do the trauma at a less favourable tariff price, and the risk is you destabilise the local health economy. No one is interested in looking at trauma and commissioning that outside of the service.

“What I want to see is a much more collaborative approach where everyone comes together to try and solve a problem that we know is a real issue.”

 

The NHS is more fragmented than ever: Are ministers prepared to provide the means required to deliver integrated care? (The Independent: 14 January 2014)

Prof Chris Ham, chief executive of The King’s Fund, writes: The Coalition Government’s NHS reforms have resulted in a degree of complexity never seen before. The reforms have also extended the use of competition by requiring many services to be put out to tender and giving the OFT a role in reviewing proposed mergers between NHS providers. Both the organisation of care and how it is provided have become more fragmented as result. Is it therefore credible for Jeremy Hunt and Norman Lamb to argue that care needs to be integrated to meet the needs of older people and others with complex needs? The answer depends on whether Ministers are prepared to provide the means that are required to deliver integrated care.

A welcome start has been made with the decision to grant 14 areas of England the status of pioneer communities with support to take forward integrated care at scale and pace. Equally important is the transfer of almost £4 billion from the NHS ring fenced budget into the Better Care Fund. This will be available to all areas of England to pump prime services that bring together health and social care. Ministers must also be willing to review the role of the OFT in mergers, ensure the Care Quality Commission assesses how organisations work together, and insist that the right incentives are in place to develop integrated care. They must make it clear that competition should be used selectively rather than as an organising principle. Failure to do so will make the government vulnerable to the charge that it is intent on undermining an institution that remains dear to the hearts of the British people.

 

The NHS is more fragmented than ever (The Independent: 13 January 2014) 

The Coalition Government’s NHS reforms have resulted in a degree of complexity never seen before. The reforms have also extended the use of competition by requiring many services to be put out to tender and giving the OFT a role in reviewing proposed mergers between NHS providers. Both the organisation of care and how it is provided have become more fragmented as result. Is it therefore credible for Jeremy Hunt and Norman Lamb to argue that care needs to be integrated to meet the needs of older people and others with complex needs?

 

HIV care warning - specialists' concern over the future of HIV care after NHS changes (BBC News: 1 December 2013)

Specialists in the field of HIV care have warned that the changes that are being made to the NHS could affect the provision of HIV treatment in the future. As part of the reorganisation of the health service, responsibility for sexual health has been passed to local authorities, but treatment for the effects of HIV is still in the hands of the NHS. A significant proportion of specialists in HIV treatment felt that this arrangement has worsened patient care, when responding to a survey carried out by the British HIV Association. One third of the 100 HIV specialists surveyed thought that HIV care had worsened since the re-organisation in April, and two-thirds thought that care is set to deteriorate further. Dr Janet Wilson, president of the British Association for Sexual Health and HIV (BASHH), said: "Sexual health clinicians have been sounding the warnings around restructuring since the introduction of the government's health reforms.” She added: "We need government, national and local agencies to urgently work together to prevent HIV and GUM (genitourinary medicine) care going backwards." 

 

MPs slam NHS re-organisation (Unite: 7 November 2013)

North London Labour MPs David Lammy and Jeremy Corbyn and former Islington council leader Catherine West joined more than a dozen campaigners and patients highlighting attacks on the NHS at a public meeting in Archway on 1 November. “I don’t know where to go to challenge decisions that are now being made,” said Tottenham MP David Lammy. “The landscape of health organisation is very confusing. It’s difficult for me as an MP.  God knows what it is like for constituents.” He registered particular concerns over the closure of mental health crisis centres in Enfield and Haringey. “It is unacceptable that people suffering acute mental disorder and psychotic episodes should have to present themselves in A&E. I can tell you now there will be a terrible tragedy. Islington North MP, Jeremy Corbyn, said, “I am fearful for the future of the NHS. GPs are under enormous pressure and patients are reporting growing difficulties getting appointments and access to healthcare. Instead of sensibly planning how to meet health needs, we have duplication of resources and competition among hospitals,” said Jeremy Corbyn.

 

Concerns over single-specialism 'integration' plans (HSJ: 1 October 2013)

Senior figures in healthcare have questioned moves by clinical commissioning groups to introduce “integrated” care pathways for single clinical specialisms, such as cancer or cardiology.

The King’s Fund think tank has led calls for a focus on integrated care in recent years. However, several of its leaders told HSJ they were now concerned that redesigned services focused on a single issue – described as “carve-outs” – could cause fragmentation, and create new “silos”.

HSJ reported last month that many CCGs had begun tendering, or were planning to tender, for contracts to provide redesigned services for single-specialism care pathways.

Examples include Bedfordshire CCG, which plans to contract Circle as its prime provider for all musculoskeletal services; Bexley CCG, which is consulting providers over integrating cardiac services; and Tameside and Glossop CCG, which is planning a single contract for diabetes care.

Meanwhile, a group of Staffordshire CCGs wants to establish a single contract for cancer services.

King’s Fund senior policy fellow Nigel Edwards told HSJ: “The minute you bunch stuff up together, you run the risk of creating new and different problems with integration.

“If you integrate one vertical silo you create new opportunities for a lack of integration with other ones.”

Some contracts currently being considered appeared to be a “carve out” of particular services rather than an integration project, he added.

Mr Edwards said integrated services should ideally cover a broader population than a cohort of patients with a particular condition.

He said separating specialisms was more problematic for conditions whose care pathways more commonly overlap with others, such as cardiac or cancer care. In these cases a patient with more than one long term condition could see their care fragmented between separate contracts.

 

Cornwall's health service 'fragmented', hospital governor says (BBC News: 25 October 2013)

A bed-blocking row has highlighted Cornwall's "fragmented" health service, a local health governor has claimed. The Royal Cornwall Hospital Trust (RHCT) cancelled 14 operations on 7 October because it was unable to discharge patients. It cited a lack of community beds and social care support - services provided by Peninsula Community Health Trust and Cornwall Council. RCHT governor Graham Webster said agencies had a lack of communication. "The system has become very fragmented," Mr Webster, who is also vice chair of Health Initiative Cornwall, told BBC News. He added it was concerning that some elements of health care were no longer part of the NHS, but provided by what were "essentially private contractors". "A lot of these agencies have been working in their own interest, rather than in the interest of patients," he added. Mr Webster said demonstrated the poor communication between the different partnerships. He said: "There was quite clearly a cap in the various procedures and systems which should have been followed. "We weren't even working to the same policy, which is very surprising and very disappointing."

 

Serco condemned over move to offload troubled GP service in Cornwall. (The Guardian: 11 October 2013)

Serco, the private contractor that falsified its NHS data in Cornwall, is looking to pass on its troubled GP out-of-hours service in the county to a subcontractor. The Guardian has learned that Serco has been in talks with the NHS to hand delivery of the service to Devon Doctors, a not-for-profit enterprise run by GPs in neighbouring Devon. Margaret Hodge, chair of the parliamentary accounts committee (PAC), which held an inquiry into Serco's performance in Cornwall earlier this year, described the move to offload the contract as outrageous. "It's absurd that the government contracts with one company, which can't cope and misleads us all, and the company then just hands the job over to another. How on earth can you have proper accountability like this ?" she said. Serco's negotiations over subcontracting follow a Guardian investigation which revealed it had falsified its performance data when reporting to the local NHS trust so that it appeared to meet targets in the contract that it failed to achieve…. Clare Gerada, chair of the Royal College of GPs, said subcontracting NHS contracts would lead to a fragmentation of service, which could damage patients' interests. "Serco hugely underestimated the complexity of out-of-hours provision in bidding for the contract," she said. "Now commissioners are tied up in a contractual and competition nightmare, when the most sensible thing would be to break the contract and invite local doctors to provide the service, which is what they were doing before the existing co-op was dismantled for this contract."

 

Record number of private operations in 'two-tier' health service (The Mirror: 20 September 2013)

Hard-up NHS hospitals are doing record numbers of private operations to stay afloat. Shock figures show their income from private patients rose 12% last year – with a further 10% rise forecast for the next 12 months. Worried doctors fear the figures reveal the Tories are creating a two-tier NHS – with those who pay gobbling up scarce resources. Under the controversial NHS shake-up, hospitals can now earn up to 50% of income from private work. A Freedom of Information request by Labour MP Gareth Thomas revealed English NHS hospitals earned £434 million from private patients in 2012/13, up £47 million in a year. Hospitals are forecasting they will earn even more this year (2013/14), raking in some £480 million from private work.

 

Campaigners trying to save hospital services launch a further Protest (Hastings and St Leonards Observer: 11 September 2013)

Hospital campaigners battling to save services at the Conquest from being cut have protested against NHS bosses’ latest proposals.

Members of Hands off the Conquest staged the demonstration in Priory Meadow Shopping Centre at the same time hospital managers held a meeting to explain their plans to change general surgery services, musculoskeletal and orthopaedic services, and stroke services. Health bosses have admitted up to 15 patients a day will have to travel either to Eastbourne or Hastings if the proposals come into effect. General surgery deals with abdominal organs, such as the stomach and intestines, and the higher risk and emergency work will be based at either the Conquest or Eastbourne’s DGH. Emergency orthopaedics, such as fractured hips, would also be centralised at one or the other hospital, similarly with stroke services. Margaret Williams, chairman of Hands of the Conquest, said: “We have had members of the public coming up to us worried that the Conquest will close eventually. They all think it’s about saving money.”

 

CCGs line up raft of 'prime contractor' deals (HSJ: 14 August 2013)

Dozens of clinical commissioning groups are devising innovative contracts in which a lead provider receives an outcomes based payment to integrate an entire care pathway, HSJ can reveal.

The news comes after Bedfordshire CCG on Monday named private company Circle as its preferred bidder to be “prime contractor” for an integrated musculoskeletal service.

If the £120m deal is finalised, Circle − which also runs Hinchingbrooke Health Care Trust − will be financially and clinically accountable to commissioners for the whole pathway. The CCG said this previously involved 20 contracts across primary, secondary and community services.

Bedfordshire is the most advanced CCG in introducing this type of system but HSJ has identified a raft of similar deals in the pipeline.

These include a group of CCGs in Staffordshire planning to commission cancer and end of life care based on outcomes, and Oxfordshire’s proposal to bring in lead providers to integrate maternity, mental health and older people’s services.

Bedfordshire CCG director of strategy and system redesign Diane Gray told HSJ: “About 30-odd CCGs have been in contact with us about the work we are doing here.”

She said they fell into two categories: those considering delivering integrated musculoskeletal services and those interested in outcomes based approaches. It is understood neighbouring Cambridgeshire and Peterborough CCG, which is tendering older people’s services worth £1bn, is among those in contact.

The prime contractor model involves a single organisation subcontracting work to other providers to integrate services across a pathway. A proportion of payments is dependent on the achievement of specific outcomes.

About £4m-£6m of the Bedfordshire contract is dependent on Circle making “game changing” alterations that will improve patient outcomes and service sustainability. HSJ understands the CCG is working informally with consultants to ensure the contract gives it sufficient power over the lead provider.

NHS Partners Network chief executive David Worskett welcomed the model as an “innovative and imaginative” commissioning solution. However, Sir John Oldham, who led a series of integrated care pilots for the Department of Health, said other models could be better suited to some areas of provision.

He said “alliance contracting” − in which a commissioner issues one contract binding several providers − scored highly in the year of care capitation tariff pilots, which looked at people with multiple long term conditions.

Commissioners found this model “created the more cooperative behaviours… in the system” while the prime contractor model risked creating “adversarial” relationships between prime and subcontractors, he added.

 

Eastbourne Hospital paediatricians in 'catastrophe' warning (BBC News Sussex: 24 May 2013)

Consultant paediatricians at Eastbourne District General Hospital have said that the newly configured children’s services are unsafe. The altered services came into operation at the beginning of May. East Sussex Hospitals Trust said the move to a midwife-led maternity centre in Eastbourne, with consultants based in Hastings, was a temporary measure needed to cope with staffing shortages. However, in an open letter, nine consultant paediatricians  said: " said there was a risk of “catastrophes and serious failure.”

 

GP raises alarm over fragmentation of practice services (BMA: 30 April 2013)

A GP has expressed concern about the fragmentation of NHS care after ancillary services were moved from her surgery. Lancashire GP Margaret France said many older patients now had to travel more than an hour on public transport for general podiatry services that used to be housed within her practice.

Lancashire Care NHS Foundation Trust, which holds the contracts for such services, has also transferred health visitor services from Dr France’s Withnell Health Centre to the new Buckshaw Village Health Centre about 10.5km (6.5 miles)

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