Arm’s length providers

How many GP practices are being run by NHS Norfolk or their provider arm?

Posted on December 23, 2009. Filed under: Arm's length providers, Reports/papers |

NHS Norfolk | Freedom of Information | 23 December 2009


1. How many GP practices are being run by NHS Norfolk or their provider arm? This would include both long term and temporary contracts.

2. What are the PCT’s plans for these GP practices? Is NHS Norfolk planning to divest themselves of these services and what are the time-scales for doing so?


1. There is only one practice that is run by NHS Norfolk or Provider Arm. This practice is Downham Market Health Centre and is run by Norfolk Community Health and Care.

2. NHS Norfolk has no current plans regarding the future of this practice.

Please be aware that although the information on this page was accurate at the time of publishing, it may not now be, and should not be relied upon.

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NHS Southampton City and NHS Portsmouth agree to combine community healthcare providers

Posted on December 21, 2009. Filed under: Arm's length providers, Press/News Releases |

Southampton Community Healthcare | About us | News Release | accessed 21 December 2009

NHS Southampton City and NHS Portsmouth Trust Boards have this week given their approval to integrate their provider arms, Portsmouth Community and Mental Health Services and Southampton Community Healthcare.
NHS Portsmouth’s Trust Board today agreed to proposals outlined in the joint full business case which follows the same decision taken yesterday (Thu 19 Nov) by NHS Southampton City.

Following today’s decision, the full business case will now be considered by South Central Strategic Health Authority (SHA) and the Department of Health. If accepted, this decision will mean that as of 1 April 2010, a new NHS community and mental health services provider will be created. As part of this decision, Portsmouth Community and Mental Health Services will transfer across to NHS Southampton City from April 2010.

The current teams will now continue to work together in developing the agreed proposals and shaping services to meet the needs of patients.

Bob Deans, Chief Executive Officer for NHS Southampton City which runs Southampton Community Healthcare and will host theintegrated services, said: “Creating a single NHS community provider, through the integration of Southampton and Portsmouth’s respective provider arms, will allow us to keep services local and provide patients with improved quality of care, increased choice and an even better patient experience. This positive decision will also allow the local NHS to revolutionise the delivery of community services across Southampton and Portsmouth which will benefit both patients and staff.”

Tracy Sanders, Chief Executive of NHS Portsmouth, the Primary Care Trust that currently runs Portsmouth Community and Mental Health Services, added: “By taking this decision, we’re not proposing that patients in Southampton travel to Portsmouth or vice versa to use services. Instead, the decision will allow us to create one dedicated provider through which we can share best practice and deliver improved services to patients across both areas. As we move towards April 2010, we will further develop the proposals we have in place to ensure a smooth integration. The decision by NHS Southampton City and NHS Portsmouth will create a provider with increased financial stability for the years to come and one which is able to offer improved access to healthcare services for patients.”

This decision follows guidance published in Transforming Community Services: Enabling new patterns of provision, published by the Department of Health, which states that Primary Care Trusts must develop a detailed plan for the future of provider services and review the options for most appropriate organisational form.


Notes for Editors:

NHS Southampton City is responsible for investing in health and care services to effectively meet the needs of the city’s population.

Southampton Community Healthcare is the provider arm of NHS Southampton City. As a provider organisation, Southampton Community Healthcare delivers NHS services in the community.

NHS Portsmouth is responsible for commissioning and providing local health services.

Portsmouth Community and Mental Health Services is the provider arm of NHS Portsmouth, responsible for a wide range delivering a wide range of community health services across the city, and further afield, to meet local health needs.

The Transforming Community Services (TCS) programme aims to improve community services so that they can provide modern personalised and responsive care of a consistently high standard. To find out more visit

The transferring of Portsmouth Community and Mental Health Services to NHS Southampton City will take place via Transfer of Undertakings (Protection of Employment) Regulations 2006 (TUPE).
Following this decision by the respective Trust Boards, a merger proposal will now be presented to the Department of Health, for implementation from 1 Apr. The Full Business Case will now be considered by South Central Strategic Health Authority and various Department of Health Boards

For more information please contact:

PORTSMOUTH: Pat Forsyth, NHS Portsmouth on 023 9268 4835.

SOUTHAMPTON: Matthew Butler, NHS Southampton City on 023 8029 6930.

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Merger of Ealing PCT’s provider services arm, Harrow PCT’s provider services arm and Ealing Hospital NHS Trust

Posted on December 18, 2009. Filed under: Arm's length providers, Integrated care, Reports/papers |

Co-operation and Competition Panel | accessed 18 December 2009

Ealing PCT’s provider services arm, Harrow PCT’s provider services arm and Ealing Hospital NHS Trust are proposing to merge to form an Integrated Care Organisation.

Consistent with its draft interim merger guidelines, the CCP will examine the costs and benefits of the proposed merger to patients and taxpayers, in order to ascertain whether it is consistent with Principles 9 and 10 of the Principles and Rules of Cooperation and Competition.

In doing so, the CCP will consider the effect of the transaction on patient choice and competition for community or secondary health services in Ealing and Harrow or a wider area.

The CCP would welcome submissions in writing from interested individuals and organisations on this issue or on any other matter relevant to the CCP’s assessment of this transaction under the Principles and Rules of Cooperation and Competition. To submit evidence please email Ealing&

The closing date for submissions is 8 December 2009.

Case documents

Notice of Acceptance (02/12/09) [243 KB]

Administrative timetable

Event Date
CCP publishes Notice of Acceptance 1 December 2009
Closing date for Phase 1 submissions 8 December 2009
Deadline for completion of Phase 1 * 29 January 2010
Deadline for completion of Phase 2 (if required)** 24 May 2010

* At the end of Phase 1, the CCP will either:

  • recommend that the merger be allowed to proceed, or
  • recommend that the merger be allowed to proceed subject to measures agreed with the parties that address concerns identified by the CCP during Phase 1, or
  • proceed to a more detailed Phase 2 investigation.

** Phase 2 allows the CCP to conduct a more in-depth investigation where this is required to fully assess a merger.

NB. This timetable will be updated as required during the course of the inquiry.

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Independent provider arms ‘nonsense’, David Nicholson says

Posted on November 27, 2009. Filed under: Arm's length providers, News stories |

Healthcare Republic | By Dave West | 27 November 2009

NHS chief executive David Nicholson has described the idea of many primary care trust provider arms becoming independent as “nonsense”.

It confirms that the policy of asking community providers to become separate foundation trusts or social enterprises has been abandoned.

Instead, Mr Nicholson appeared to give his strong support to “vertical integration” of community providers with acute trusts.

Speaking to the NHS medical directors summit yesterday, Mr Nicholson said: “The idea that at a time when we are facing real financial challenge, that we’ll start creating a whole new set of NHS organisations is nonsensical.”

In particular, he said the idea of many PCT providers becoming foundation trusts was “nonsense”.

“We have got to move from that quickly and think of alternatives ways of doing it.”

He said cost-saving improvements could often be made at the “interface” between providers and this was a case for integration, with acute or other providers.

Mr Nicholson said: “I would say to those in acute andcommunity services you should be talking long and hard to each other.”

He said “vertical integration” was “a real opportunity to improve services right across whole pathways”.

The co-operation and competition panel is currently investigating three proposed mergers of community services with acutes, from NHS West Sussex, NHS Lewisham and NHS Derby.

It has not yet ruled on any vertical mergers but has approved the transfer of NHS Barking and Dagenham’s community health services to North East London Foundation Trust, a mental health services provider.

As recently as April, PCT providers were pressing for all to be allowed to become foundations, rather than only the six existing pilot sites.

However, in August Mr Nicholson scrapped an October deadline for PCTs to outline plans for their provider.

Yesterday he accepted the DH had not “covered ourselves in glory” with its community services policy.

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Safety in numbers: the rise of the GP federation

Posted on November 17, 2009. Filed under: Arm's length providers, Federations, News stories, Providers, Social enterprise | Tags: , |

Pulse | By Nigel Praities | 17 November 2009

It’s two years since the RCGP proposed its ‘roadmap’ for general practice, which envisaged practices working together as federations, pooling skills and resources to broaden the range of services on offer in primary care.

Many at the time thought it would go the same way as the Middle East roadmap for peace. Yet increasing evidence is emerging that GPs are experiencing a major shift in the way they work, some more voluntarily than others.

Nigel Praities investigates the growing move towards new models of working and asks if federations are now the only way forward.

Where does the idea of primary care federations come from?

The RCGP’s ‘roadmap’ was largely designed to steal a march on the market-based approach being spearheaded by Lord Darzi and his NHS Review.

The concept was one of primary care federations giving patients better access to services with change being championed locally by GPs, rather than through ‘one-size fits all’ plans from central Government.

Initially federations were seen as nothing more than glorified practice-based commissioning hubs, but a 2008 paper from the RCGP was crucial in putting more flesh on the bones of the federation concept.

Federations, the paper said, could give practices ‘economies of scale’ they could not achieve otherwise, by sharing back-office functions and directly employing managers and nurses to provide new services.

It gave a list of characteristics a federation should have, including a formal legal structure, an executive management team and a written public constitution.

What evidence is there that federations are beginning to evolve?

There are no official numbers on primary care federations in the UK but, anecdotally at least, it seems more practices than ever are working collaboratively.

Pulse has uncovered evidence of practices linking up in all areas of the country – from the centre of post-industrial Sheffield to the rural heart of Worcestershire.

Trailblazing schemes in Croydon and South London have been followed by other partnerships, with some practices forming limited companies or provider arms.

The schemes involve nearly 300 practices in a wide range of different models, from collaborations with private companies to organic growth from successful PBC hubs.

In Sheffield is a group of 90 GPs working in an area with high deprivation and social need that is heading towards a federated model.

It directly employs specialist nurses to run diabetes and ENT clinics in the community and is working on several schemes to bring other services closer to home, such as midwives to provide obstetrics clinics in GP surgeries.

All the 28 practices in the consortium sign an agreement and work with centrally employed practice managers. They have also formed a provider company this year, Central Care Sheffield Ltd, to take on their projects and save administrative costs.

Paul Wike, Primary Care Lead Manager at the consortium, says: ‘It is safety in numbers, they have another 26 practices standing should-to-shoulder.’

What different models have emerged?

As in Sheffield, many of the practice groupings have grown organically out of PBC clusters or consortiums.

GPs in Brent have recently set up a federation council that contains representatives from the five PBC local clusters. It sits on an executive council with the PCT and looks at how services can be commissioned all over Brent

Dr Ethie Kong, a GP in Brent and member of the federation council, says it gives GPs a powerful voice in how primary care services are commissioned for areas such as improving health inequalities and care for long-term conditions.

‘Some of the needs are common and some specific to the locality. We work within our clusters, and across clusters, and Brent-wide we liaise with the PCT.

‘This means we have local autonomy as well as borough-wide co-operation,’ she explains.

Services are currently provided by the PBC clusters themselves under a not-for-profit social enterprise model, but this may change in the future.

Other areas are working closely with private companies to form provider companies. A network of 22 practices in Worcestershire have formed a ‘GPCo’ through a 50:50 partnership with the company Assura.

Assura provides money to set up the company and shares the profits with the GPs. A statement from Assura says it enables GPs to ‘exploit the economies of scale that a national organisation brings’ by reducing the costs of service design, bid management and service implementation.

‘Due to the fact Assura operates nationally, all of its members are able to benefit from its bulk purchasing power of equipment and utilities, as well as understanding how other localities provide services more efficiently,’ the company says.

PCTs are also seeing the benefit of making practices work together. NHS Tower Hamlets has recently dangled a massive £12million carrot in front of their practices to fund the development of new care pathways and ‘networks’ of GP practices.

As Pulse revealed last week, the PCT – in one of the poorest parts of the country – brought in the external consultants McKinsey to assess their primary care services.

They recommended a 40% increase in funding for primary care and that this should be used to develop networks – with hubs for each care package – and would eventually include specialists, local voluntary organisations and the borough.

Are there any dangers for GPs?

One risk is that the schemes will cause GPs to surrender the protection of their nationally negotiated contracts.

In Tower Hamlets, the additional investment in primary care is dependent on all practices switching to APMS. That could be a bad decision in the long-term, as their contracts could be rewritten at the whim of the PCT or handed to private providers.

The involvement of private companies could also open up GPs to criticism they are profiteering rather than seeking to improve the care of patients.

Dr Michael Dixon, chair of the NHS Alliance, says the way GPs develop their federations will be crucial to whether they survive or not.

‘There are some really big questions here that general practice has to ask itself – are we in it to make a short-term profit or for the long term to make services more responsive to local patients?

‘I think a social enterprise is the best model, because it is really important the extension of services is seen as something done for local people, rather than tabloid headlines saying we are “fleecing” local people again.’

There is also a danger federations will bite off more than they can chew. They are able to take on more risk than an individual practice, as it can be spread more thinly, but this could backfire.

A PBC federation of 32 practices in Bexley made £4m worth of savings after being given real budgets for prescribing last year, but they also took on responsibility for 54% of any overspend, which could have cost them tens or hundreds of thousands.

What does the future hold?

If Tory plans are anything to go by, GPs could see themselves with much greater responsibility for commissioning and real budgets written into their contracts from next year.

This could push those not currently in a federation into thinking about how they can work closer together and become more business-like in the way they organise commissioning.

The NHS Alliance is due to launch a paper this month on developing ‘local care organisations’, extending the federation model to secondary care and other partners.

This model – similar to the networks planned by Tower Hamlets – could see the traditional barriers between different aspects of healthcare being blurred, ideally with GPs driving the changes.

This is the best case scenario, but whatever happens GPs working on their own is likely to be a thing of the past. The formation of federations may be the only way to ensure GP practices remain the basic unit of care for patients, albeit with risks.

As Dr Dixon warns: ‘Whichever party is in power next year, there will be a much bigger drive to emancipate these organisations. Whatever happens there will be change, and GPs should be developing these systems in readiness.’

RCGP chair Professor Steve Field is in no doubt federations are the future.

‘This is the way forward,’ he says. ‘The most important thing is strong GP leadership and that patients are at the centre of it.’

Increasing numbers of practices appear to be heeding that call.

How GP Federations are progressing across the country

1. Bexley: PBC federation of 32 practices that was responsible for making a £1.4 million saving in prescribing cost last year and is now looking at working with consultants to develop new pathways of care

2. Brent: Initially a PBC cluster of 67 practices, it has now progressed to have a GP Federation Council and is involved in all mainstream commissioning and planning

3. Worcestershire: 22 practices working in a ‘limited liability partnership’ with the private company Assura to develop PBC opportunities

4. Lincolnshire: Cluster of 14 practices that is registered as a ‘limited provider company’ and has worked to ensure their local hospital survives by having primary care-led acute medical beds, a GP-led A&E department and holding additional diagnostics in the community

5. Croydon: Led by RCGP fellow Dr Agnelo Fernandes, it is made up of 16 local practices covering 140,000 patients. Recently it won an award for its diagnostics-in-the-community project, providing ultrasound, echocardiography and direct-access MRI

6. Surrey: Epsom Downs Integrated Care Services is a collaborative venture involving a federation of 20 practices in Surrey. It has established nearly 30 new community clinics, enabling over half of out-patient consultations to take place closer to home

7. Sheffield – Consortium of 28 practices that has been working on schemes to improve prescribing and community services for chronic pain and COPD. Has just set up their own provider company – Central Care Sheffield Ltd

8. South London – RCGP vice-chair Dr Clare Gerada’s group of five GP practices across Southwark and Lambeth has set up new musculoskeletal clinic and gynaecological services and was mentioned as a good practice example in the Darzi review

9. Tower Hamlets – Revolutionary plans for primary care ‘networks’ with a hub for each long-term condition, with GPs working with specialists and community/social care services and local voluntary groups

10. Kingston – The Kingston Co-operative Initiative is a not-for-profit limited company overseeing PBC on behalf of 27 practices. Runs an education and support service and a GP-led referral management scheme. Also developing a service provider arm.

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Health trust faces legal review

Posted on October 30, 2009. Filed under: Arm's length providers, News stories | Tags: |

Hull & East Riding Mail | 30 October 2009

A judicial review has been called for over NHS Hull’s decision to transfer frontline health services to a social enterprise company.

As previously reported in the Mail, the primary care trust (PCT), wants to transfer staff and services, including district nursing and health visiting, to City Health Care Partnership (CHCP).

Now, the move, which has faced criticism from unions, has been delayed after NHS Hull received a call for a judicial review.

The trust said it was initially served notice of a proposed claim for a judicial review “by an individual” last month.

The claim was disputed by NHS Hull’s solicitors, but the PCT has subsequently received a formal claim.

It now has to file a “formal acknowledgement of service” to the court by mid-November and the court will then decide whether or not to undertake a judicial review.

Tina Smallwood, director of human resources at the trust, said it is aiming for the services and staff to separate from NHS Hull during or before March.

However, this could be delayed further if the courts decide to review the decision.

Ms Smallwood said: “NHS Hull has received a claim for judicial review.

“This means a legal challenge has been made against the decision taken by NHS Hull to transfer its provider arm to a community interest company.

“The primary care trust is required to compile a response by mid-November, following which the case may enter the judicial system.”

As reported in yesterday’s Mail, Unite, alongside other staff unions, will be asking managers at the PCT to hold a ballot of the staff as to whether they are in favour of transferring to CHCP.

Ray Gray, regional officer for Unison, said: “We are aware of the judicial review.

“I believe it’s two patients who have asked for it.

“The reason they have done it is because the public weren’t consulted and they were completely unaware of it.

“In April, the trust said it was advised by solicitors it didn’t have to consult the public. That’s a stupid move.

“It’s a major change to health services in Hull and there’s no way they can get away with it without consulting the public.”

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The future of West Essex Community Health Services

Posted on October 26, 2009. Filed under: Arm's length providers, Integrated care, Providers, Reports/papers, Social enterprise |

NHS West Essex Community Health Services | September 2009 | accesssed 26 October 2009 (pdf)

West Essex Community Health Services (WECHS) is the current provider arm (arms length trading organisation) of NHS West Essex. 

What is a social enterprise?

Social enterprise is a “badge” that a company or charity can adopt that brings certain benefits and says certain things about the ethos of the business. 

The key defining characteristics of a social enterprise are that it is not for profit, it works for the public benefit and any surpluses it makes are re-invested in the organisation. Beyond that social enterprises can be modelled in different ways to support the specific aims and purpose of the organisation. 

What all social enterprises share is an enterprising, innovative, business-based approach to achieving social and environmental aims.

A social enterprise can access monies through the Social Enterprise Investment Fund (SEIF) which an NHS trust is unable to do.

What is a not for profit company and how might it work?

The company is owned by staff who could be the shareholders. It is possible that it would be structured as a
company limited by shares of a nominal value, for example £1 each. The shares would be owned by staff and would not be available for resale. This means that staff could be the true owners of the business but without any personal financial risk. 

Shares could not be transferred and this would mean the business could not be bought by a third party. Any money saved or made by doing things better, differently, or by marketing developing services and products, could be re-invested for the benefit of patients and staff. If the company made a loss, it would need to look for greater efficiencies, just as an NHS trust would have to.

An alternative to a social enterprise

• PCT provider unit (current arrangement) 

This would be an arms length trading organisation (ALTO) within the PCT, led by a provider board and accountable to the PCT. This is essentially the structure which has been in place since April 2008. This is unlikely to remain an option given the long standing national policy to separate the commissioning and provider functions of PCTs. How long we could stay as an arms length trading organisation is unclear. There has been a public verbal statement from the Department of Health that ALTO will not be acceptable after April 2010, but this has not yet been enshrined in policy or guidance – the PCT Board are clear that this is not a long term option for WECHS.

• Community foundation trust (CFT)

CFTs are independent organisations accountable to Monitor, an independent regulator, and not the Department of Health. They are legal entities in their own right – the PCT Board consider this not a viable option as WECHS is considered too small an organisation to become a CFT in its own right and would have to consider joining with another provider arm to pursue this option. This would not necessarily encourage the focus on local communities or integration with primary care which is at the heart of commissioning intentions. In any case there is little chance of many more community foundation trusts being established and the infrastructure costs of a new trust may in any case be unaffordable given the recession.

• Horizontal integration with other community care services

Integration of care services provided by the PCT with other community care services provided to the same population by other government agencies, and in particular by the local authority. This is not an option the PCT Board currently believes serves the needs of their commissioning plans. Currently many local authorities are transferring their directly provided services to the private or third sector. But not in partnerships with local GPs

• Vertical integration with an acute trust 

Integrate the PCT’s community services with acute care provided by Princess Alexandra NHS Trust or a neighbouring acute foundation trust – the aim of the commissioning plan is to transfer services from acute care to community and primary care settings not to increase the size of portfolio of acute services.

• Horizontal integration with a non acute trust for example mental health 

While these trusts often have a strong community focus which might be beneficial they also cover large geographical areas and are usually very specialised in what they do. This might detract fromlocally sensitive services.

• Managed dispersal

Through the procurement plan, services are gradually transferred to the organisations successfully awarded a contract. It is likely though that WECHS will need a temporary host while this happens as NHS West Essex are clear that they will not remain the hosting organisation.

• Integration with primary care forming a social enterprise model

Community services would be integrated with primary care services within west Essex. Staff and potentially GPs establish an organisation themselves which provides community services. This may be registered as a social enterprise, a not for profit organisation, working for the public benefit, that can re-invest any surplus in services – this is the PCT Board’s preferred option at this time and on which staff are now being consulted through this consultation paper.

• An integrated organisational model led by local GPs

This would be a company which would have a contract with the PCT. Apart from the social enterprise model described above, this is the only model that would secure the same benefits for patients of a locally focussed integrated service provider. For this reason, this is the PCT’s present preferred alternative option if staff do not want to establish a social enterprise.

Big Changes For Staff And Patients At Saffron Walden Community Hospital

Saffron Walden Reporter | 23 October 2009

A SHAKEUP in the way health services in the region are run could mean big changes for staff and patients at Saffron Walden Community Hospital.

Some of the services currently delivered by NHS West Essex – the primary care trust (PCT) which covers Uttlesford – could become part of a new independent organisation.

If the plan gets the go-ahead it would mean that the hospital, as well as many other services such as district nursing and health clinics, will become a separate not-for-profit company known as a social enterprise.

Branch chairman of Unison (the union for public sector workers), Terry Ward, believes the proposals could give a raw deal to employees and service users.

“If this split happens then it’s possible that the PCT will buy cheaper services from elsewhere, rather than the facility at Saffron Walden, which makes a mockery of the idea of a community hospital,” he said.

“And staff, who have worked for the NHS for a long time and want to continue to work for the service which they are very proud of, are now being asked to privatise themselves.”

“A lot of resources are being used to push the social enterprise model and we want to make sure that employees are fully aware what they are voting for.”

There are a number of alternatives to privatisation and staff will be given a vote on December 9, after a 90-day consultation, on whether to adopt the idea.

The vote concerns the future of the provider arm of the PCT, known as NHS West Essex Community Health Services, which has an annual income of £34 million and employs nearly 1000 people.

It provides health services in community hospitals, clinics, health centres, GP surgeries, children’s centres, schools and other locations across Uttlesford, Harlow and Epping Forest.

Managing director Vince McCabe said: “What ever happens, local people will continue to receive all their NHS services as they have before, free at the point of delivery, paid for out of the public purse and commissioned by NHS West Essex.”

He added that the social enterprise model would be the best way to “protect and develop” services for the future.

“It would give our frontline staff greater freedom to make decisions closer to patients,” he said. “They would also have a bigger say in how things are run.

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Two thirds of PCTs still to agree provider model

Posted on October 8, 2009. Filed under: Arm's length providers, Journals, Social enterprise | Tags: |

Health Service Journal | By Steve Ford | 8 October 2009

Two thirds of primary care trust provider arms have not yet had their future form agreed by their board and strategic health authority, a survey suggests.

According to a survey of 83 PCT provider arms, one third said their service model had been agreed by their PCT board and the SHA before 1 October.

This was the original deadline – now dropped – set out in the NHS operating framework for 2008-09 and the government’s Transforming Community Servicesguidance.

Around 40 per cent of providers said they had changed their plans as a result of the removal of the timetable, while the rest indicated that they were significantly advanced in their planning and were not changing pace.

The survey, carried out by the PCT Network, found that most PCT providers welcomed the relaxation of the original deadline for developing their plans.

A minority of respondents were concerned that the move could slow progress.

For example, one respondent said: “We need separation closure – not as an end in its own right – but mainly in order to allow us to move on.

“There is a danger as far as we are concerned in the perpetuation of uncertainty.”

The results of the survey, carried out in September, were announced on Tuesday at the network’s community services conference in London.

Overall most providers said they intended to “stay in house”, (29 per cent), or seek community foundation trust status (28 per cent). Only 4 per cent intended to become a social enterprise scheme.

Where decisions on provider models have been agreed, the preferred option was slightly more in favour of becoming a community foundation trust than remaining as providers within the PCT.

This trend was reversed for provider arms where no formal decision has been made.

The majority of providers, 58 per cent, said their planning had not been affected by the creation of the co-operation and competition panel in January.

Most were also positive about the panel’s impact, saying that it had improved dialogue with commissioners.

However, while the removal of the deadline was intended to allow increased focus on transformational change rather than form, the survey revealed that there was some way to go on commissioning and contestability plans for community services.

More than half, 56 per cent, said their commissioning arm did not have such a plan in place, although many commented that plans were in progress and would be presented to PCT boards before the end of the year.

PCT Network director David Stout said: “The removal of a deadline to agree upon organisational form has allowed providers to focus on transforming the quality and efficiency of services without being fixated on a timetable in which to change their model.

“However, it is important that the momentum for this transformation is not lost,” he added.

Providers were also asked to highlight their top priorities.

Top six priorities:

  • Quality and patient experience
  • Improving productivity and value for money
  • Clinical care pathways
  • Workforce transformation
  • Integration and partnership working with local authorities and primary care
  • Metrics/data and IT
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NHS Plymouth provider arm

Posted on October 6, 2009. Filed under: Arm's length providers, Reports/papers |

NHS Plymouth | FOIA 671 | 6 October 2009

Item 1: Has your provider arm achieved Autonomous Provider Organisation (APO) status?


Item 2: If not, when will you reach this stage?

NHS Plymouth does not hold this information because no date is set.

Item 3: What is your decision for the future organisational form of your provider arm?

NHS Plymouth has a signed memorandum of understanding with the Local Authority to develop a more integrated approach to the delivery of care.

Item 4: Are you taking part in a Department of Health pilot scheme?


Item 5: Please can you provide a list of the services your provider arm offers?

Please see file entitled ‘Business Plan 2008-09’, attached below.

Item 6: Please can I have a copy of your Provider Arm Annual Report 2008/09?

Please see file entitled ‘Business Plan 2008-09’, attached below.

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The Private Sector and the NHS

Posted on September 4, 2009. Filed under: Arm's length providers, GP-led health centres, News stories | Tags: , , |

Pharmaceutical Field | 4 September 2009

The demands of world-class commissioning will mean increased collaboration between the NHS and the private sector. To stay ahead of the game, pharma companies need to be engaging with the private sector on a local level, argue Duncan Alexander and Mike Sobanja.cover


Despite many initiatives and government policies, the private sector has yet to play any major role within the NHS – especially outside England. Yet with escalating cost pressures and the very real prospect of a new government in 2010, there is little doubt that Strategic Health Authorities (SHA) and Primary Care Trusts (PCT) will begin to look more closely at opportunities for commercial partnership.

Indeed, while there is limited national consensus today, private sector initiatives continue to succeed at a local level. Given the current economic climate, pharma companies cannot afford to ignore these pockets of opportunity. It is only by understanding the very real differences in private sector/NHS collaboration at a local level that organisations will be able to respond effectively to the implications of strategic change, from world-class commissioning onwards.


Increasing competition

Since the Labour government came to power in 1997, there have been many grand statements and initiatives designed to increase performance and productivity across the NHS by introducing private sector competition.

Indeed, in January 2002, Alan Milburn, former Secretary of State for the NHS heralded the introduction of the private sector into the NHS, saying: “Our reforms are about redefining what we mean by the NHS. Changing it from a monolithic, centrally-run monopoly provider to a values-based system where different health care providers – in the public, private and voluntary sectors – provide comprehensive services to NHS patients.”

However, fears that such a strategy could lead to back door privatisation of the NHS certainly appear to be unfounded, with a number of initiatives failing to deliver real change or private sector involvement. And certainly across Wales, Scotland and Northern Ireland there is a clear move away from any private sector co-operation or collaboration.

But the changing economic environment will undoubtedly have a significant impact on NHS strategy over the next few years, especially in England, where the sheer volume of demand places huge cost pressures on PCTs and SHAs. Combined with an expected change of government in 2010, it is very likely that the NHS will be tasked with meeting clear targets for the use of private sector organisations to deliver services in a more competitive and cost effective manner.


Poised for change

Indeed, while the Virgin Group announced it had effectively put on hold its ambitious plans to take over and run GP surgeries in 2008, the company remains ‘very committed’ to entering the sector and will review the situation when the economy improves. 

Furthermore, the Department of Health remains bullish about the private sector’s role within the NHS, a spokesman recently asserting: “PCTs are expected to stimulate and shape the market, including a number of providers from voluntary, NHS, private, local government sectors and others.”

And private sector involvement with the NHS is occurring – albeit on a fragmented basis and at a local, not national level. Some 25% of contracts for the ‘Darzi centres’, for example, the GP-led health centres required to be introduced by all PCTs across the country, have been awarded to the private sector so far – although these include NHS hybrids that are simply relabelled organisations.

The Department for Health has also let a contract for the support of the development of practice-based commissioning, with five companies/consortia vying for contracts to give PBC a shot in the arm.


Defining opportunity

It is this highly fragmented response that is creating huge challenges for pharma companies today. And a fundamental issue to address is the speed with which PCTs respond to the demands of world-class commissioning, under which PCTs must become two separate organisations – the Commissioner and the Provider – by April 2010.

While the PCT’s commissioning side will not require many changes, it will be the establishment of the provider unit that will be of most interest, becoming as much as 80% of the PCT as it currently stands. The Department of Health has set a clear timetable for PCTs to undertake this huge change, with three stages – Arms Length Status (April 2009), Direct Provider Organisation (October 2009) and complete independence (the externalisation of the provider arm) by April 2010.

However, every SHA and PCT is progressing at its own pace – with early adopters and clear laggards. According to the latest figures from Cegedim Dendrite, 6% have achieved Arms Length Status by April 2009, 13% are significantly ahead of target and are already Direct Provider Organisations (DPO), with 66% on target to achieve DPO by October 2009.

Furthermore, different regions have adopted different strategies, with London splitting into five Commissioning Collaboratives (specialist commissioning groups) and six PCTs currently taking part in a national Community Foundation Trust Pilot Programme, under which they will be no longer be assessed by the SHA after a year’s operation and assuming the required level of governance and financial expertise.

The challenge for pharma companies is to assess and understand the progress of these individual NHS organisations in embracing world-class commissioning and understanding the implications for new business development.


Building for the future

While the private sector involvement in the NHS will undoubtedly remain small – at least until the next election, pharma companies cannot afford to ignore the opportunity. Indeed, the continued perception that both the NHS and, by association, pharma companies will be unaffected by the current economy is, quite frankly, ridiculous. With the escalating levels of public debt any government will be forced to claw back funding over the next few years. Should a Conservative government take over in 2010, the NHS is likely to experience a massive policy shift that will force SHAs and PCTs to work far more closely with the private sector.

Pharma companies cannot operate in an information vacuum. This private sector/NHS co-operation will continue to be introduced on a piecemeal, local basis. In this climate it is essential to maximise opportunities, operate efficiently and, furthermore, build relationships with key individuals who will be increasingly involved in defining the NHS/private sector model.

Without up to date information on changes in attitude and adoption at a highly granular – preferably PCT – level, pharma companies simply will not be able to respond effectively to any new commercial opportunity.



Duncan Alexander is OneKey Director at Cegedim Dendrite, where he is responsible for managing the existing client base and the co-ordination of all UK commercial activities. Cegedim Dendrite has over 35 years experience in providing value added information and CRM solutions to the pharmaceutical industry and healthcare professionals.

Mike Sobanja is Chief Executive of the NHS Alliance – the independent body that represents NHS primary care. Values-based, the NHS Alliance is the only organisation that brings together PCTs with GP practices, clinicians with managers and board members, and NHS primary care with its patients. The NHS Alliance membership and its national executive are fully multi-professional.

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Variation shows NHS community services ripe for efficiencies

Posted on August 13, 2009. Filed under: Arm's length providers, Journals |

Health Service Journal | By Helen Crump| 13 August 2009

Huge variations in the working practices of primary care trust provider arms are masking large potential efficiency savings.

An HSJ snapshot survey based on information supplied by 77 provider arms that responded to a freedom of information request to all primary care trusts revealed stark differences. Spending on community services per head of population varies from under £100 to over £200.

Almost six in 10 provider arms are working without any wireless IT systems, which would help clinical staff use their time more efficiently when visiting patients.

And some district nurses are making three times more visits to patients per week than others, for example Leicestershire County and Rutland reports 17 visits per district nurse per week while Richmond reports 54 per week.

PCT provider arms are responsible for a wide range of community based services such as district nursing and health visiting.

The sector accounts for £11bn – more than a tenth of NHS spending – and employs a quarter of its clinical workforce, but is behind the pace in terms of reform.

Although some of the differences may be down to variable data quality and different reporting methods, investigations by strategic health authorities and preparatory work for the NHS Institute for Innovation and Improvement’s Productive Community Services programme (see box) have also found large variations in practices.

Variations in community services

Variations in community services

These have led to warnings that possible funding cuts before services are re-engineered risk blocking significant savings and quality improvements further down the line.

Productivity specialists are urging managers to intensify efforts to transform service delivery.

NHS Institute director of service transformation Helen Bevan told HSJ: “If you rush into short term cost cutting measures in the face of financial pressure, you can miss massively bigger opportunities.

“The big productivity gains are around service redesign and workflow redesign. If all we do is keep doing what we currently do but try and make people work harder rather than smarter, we’re missing a massive opportunity.

“Unless we fundamentally look at the way care is delivered, we could end up doing something really horrible.”

SHAs have reported cost per health visitor contact ranges from as little as £25 to £100 per patient. A number are talking to provider arms to see whether some provider functions could be performed on a regional basis.

An SHA source said: “[Provider arms] don’t want to give up the crown jewels just yet.

“But they want to be competitive. They can’t afford to hold onto too much fat because then they won’t be able to do that.”

The source added there were many opportunities for provider arms to redesign teams with a more efficient mix of skills, but warned: “If you want to invest in getting skill mix right, some of these things take time and the clock’s already ticking.”

NHS East of England’s provider arms have begun their own benchmarking exercise.

Management consultant Paul Whiteside, who is working on the project, said providers are drawing up plans on how to improve productivity and “starting to discuss with commissioners how to release extra value”.

But he warned it would be hard for them to improve efficiency and quality without better information systems.

Community services managers said they were trying to increase the pace of reform, but needed a joined up approach from the centre if efficiencies are to be realised before the public sector spending downturn hits home.

Nottinghamshire Community Health head of service improvement and productivity Pip Dean said: “The biggest challenge is trying to demonstrate that we are striving to get into the 21st century but with comparatively limited support compared with acute trusts and GPs.

“We want to move forward quickly so support to do that would be great. We’re desperate to get mobile working because we can see the benefits for staff as well as patients.”

The provider arm was waiting for new technology, but there was a “big, quite frustrating time lag”, she said, with the provider arm’s IT specialists struggling even to find a suitable laptop for nurses.

NHS Confederation deputy director of policy Jo Webber said variations often resulted from completely different operating practices that had grown up in different areas.

But she added: “Some services are immensely good but that doesn’t mean all services are immensely good – it’s about bringing all services up to that level.”

The Department of Health’s transforming community services programme, launched in January, put provider arms and PCTs in contracting relationships and pushed for speedy reform.

But last week the DH said one of the programme’s main deadlines – to decide on new provider arm organisational structures by October – was being axed, amid fears it was distracting managers from improving service delivery.

Funding for community services is particularly vulnerable in the downturn as there is no national tariff or benchmarking data for the sector.

The Department of Health said it was still planning to pursue a local approach to currency setting for community services, except in the two areas – child health promotion and end of life care – where it is working on a national approach.

A spokeswoman said: “”The transforming community services programme recognises that we must drive up quality, innovation and productivity in community services to meet the challenges of rising consumer expectations, growing demand and a tougher financial climate.  It is important that the quality of community services be improved, because quality is fundamentally linked to efficiency.”

Productive Community Services

The NHS Institute is preparing to launch its Productive Community Services programme in October.

The institute’s early testing with six provider arms has found it is possible to increase productivity by 25 to 30 per cent from a baseline of 30 per cent patient facing time as a result of better working practices.

Other areas under scrutiny are travel time, processes, demand and capacity.

Head of the productive series Lynn Callard predicted the programme could produce bigger productivity gains than the highly successful Productive Ward programme.

But she said provider arms faced challenges around data, technology and staffing levels.

The institute is in the early stages of producing benchmarking data that can be used to improve quality and productivity in the sector.

She said: “We know there’s an issue around technology. Some people are using really good technology and some are using really limited technology – even in terms of mobile phones.

“One of the issues around working out cost is accurate collection of data and community services do struggle.

“It links in with technology because the way they collate how many visits they are doing is so highly variable.

“We’re really anxious commissioners don’t just think [provider services] are an easy target – particularly because these services haven’t been scrutinised in the past in the same way that acute services have.”

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DH scraps deadline for PCT provider arm strategies

Posted on August 7, 2009. Filed under: Arm's length providers, News stories |

Health Service Journal | Helen Crump | 6 August 2009

The Department of Health has scrapped its centrally set deadline for primary care trusts to create provider arm strategies. It comes amid fears of PCTs obsessed by organisational structure making poor decisions.

Commissioners and providers had been told to come up with “organisational options for providing community services” by October, but in a letter to PCT and strategic health authority chief executives last week, NHS chief executiveDavid Nicholson said the timetable would be dropped in favour of an SHA led approach.

Mr Nicholson said: “I have become concerned lest PCTs as commissioners and providers focus too much on issues of future organisational structure at the expense of delivering service transformation.”

He said SHAs would now determine the timetable for the future of provider arm services.

HSJ understands the DH will performance manage SHAs in this through their assurance framework.

Mr Nicholson said the move did not constitute a change in policy and was instead “about keeping PCT decisions safe, while moving faster not slower”.

The letter also stresses plans must be “cost effective” and “consistent with implementing a robust approach to quality, innovationproductivity and prevention”.

A senior Whitehall source said the letter signalled a “change in management emphasis” to focus on quality and effectiveness rather than form.

NHS Confederation PCT provider forum chair Matthew Winn said: “It’s probably helpful to take out what was an artificial timeline because some areas were really struggling to meet that anyway.”

But he warned the letter should not be used as an excuse to relax the sense of urgency.

He said: “My guess is over the next six months people will start reappraising and reviewing these plans [to see if they] are affordable and do they give the local health economy the outcomes they want. If not, they will have to be revised.”

Mr Nicholson’s letter, which was accompanied by guidance on setting up PCT provider committees, came as NHS Hull approved plans to turn its provider arm into a social enterprise at a private board meeting despite opposition.

Chair Kath Lavery said: “Instead of knocking it we should celebrate the fact that Hull is courageous and forward-thinking enough to undertake this work and to lead the way for scores of other NHS trusts.”

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Unite warns NHS staff face social enterprise transfer

Posted on July 13, 2009. Filed under: Arm's length providers, News stories, Social enterprise | Tags: |

Healthcare Republic | 13 July 2009

Union Unite/CPHVA is warning that NHS services for children and older people in Bedfordshire face being hived off into a social enterprise.  Unite the Union

Plans to be outlined to staff on Wednesday could see 1,100 staff, and services for more than 100,000 children and 420,000 older people, come under the social enterprise banner.

A letter by Andrew Harrington, chief operating officer of Bedfordshire Community Health Services (BCHS), says: ‘As an NHS staff member working for BCHS you would transfer in to the new organisation under TUPE rules. All of your terms and conditions will transfer, including your pension.’

However, Unite says that TUPE regulations do not protect pensions in this way. Instead staff may not be allowed to stay in the NHS pension scheme and if the social enterprise asks them to take on any new ‘private’ work, they will not be allowed to remain in the NHS scheme. Unite adds that new staff will not be allowed in the NHS scheme.

In a statement to Healthcare Republic, Mr Harrington said: ‘As with PCTs across the country, NHS Bedfordshire is working towards separating its commissioning and provider-arm operations.

‘Under DoH guidance, staff currently working in Bedfordshire Community Health Services are being offered the right to request the establishment of a social enterprise for children and adult services.

‘We are therefore working with our staff, at this very early stage in the process, to gauge their support, views and interest in moving these proposals to the next stage.

‘Staff are being provided with appropriate information to support them in making their own judgement on whether creating a social enterprise is in the best interests of themselves and the services. Plans will only be taken forward with their full support.

‘No decision has yet been made and developing a social enterprise is just one of the options we will be considering.’

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Southampton patients to gain improved NHS access as GP-led Health Centre contract is awarded

Posted on June 12, 2009. Filed under: Arm's length providers, GP-led health centres, Press/News Releases | Tags: |

NHS Southampton City | News Release | 12 June 2009

NHS Southampton City can today announce that a contract has been awarded for a GP-led Health Centre at the Adelaide Health Centre, Millbrook*, to open in November 2009.

Provided by Southampton Community Healthcare, which has been awarded the contract, the GP-led health centre will offer a service for up to 6,000 registered patients and help to further increase extended GP opening hours available in the City. The service will be open from 8am-8pm, 7 days a week to ensure patients have even more access to healthcare professionals in Southampton.  


The GP-led Health Centre will also be offering services for unregistered patients, including walk-in services for those with long-term conditions and chronic health needs. Long-term conditions affect a high proportion of patients in the City including diabetes, respiratory illness and chronic heart disease.


Additionally, the GP-led Health Centre will help to tackle the specific health needs of the community in the area around Millbrook by providing services needed locally. These will address health and well-being issues such as alcohol misuse, sexual health, mild to moderate mental health issues and other health and social care issues which have been prioritised according to the specific needs of those living locally.


Bob Deans, Chief Executive for NHS Southampton City said: “I am delighted that we have secured a contract for the new practice at the Adelaide Health Centre. The service will further improve access to GP services in the City and also provide walk-in facilities, which is particularly valuable for those with chronic health needs and will target specific health issues affecting the local population. NHS Southampton’s is committed to improving the health and well-being of Southampton people and we will be helping to achieve this through the community-based health services at the Adelaide Health Centre.”


Bob continued: “Patients in Southampton will already be benefiting from the fact that over 80% of our GP practices are offering extended opening hours, and the new centre will add to this access to primary care.The Adelaide Health Centre is a new state of the art facility and will be the first significant step in NHS Southampton City’s strategy to improve health and healthcare services and help it to replace some of the out of date facilities in the City. I would like to congratulate Southampton Community Healthcare on securing this contract and I look forward to the service opening in November 2009.”


Dave Meehan, Joint Managing Director for Southampton Community Healthcare said “We are delighted that Southampton Community Healthcare have been awarded the contract to provide this service at the Adelaide Health Centre. The health centre will not only improve access to primary care for people in Southampton, but will also be complimented by a range of services on the site which will help to improve the care available in the local community.”


Dave continued: “The Adelaide Health Centre will be a significant NHS building in providing excellent, community-led care for the people of Southampton and the new practice will be an important factor in makingthis possible. It is always our aim to provide high quality and patient centred services to our patients in their community wherever possible. This facility will provide us with the opportunity to deliver services in the heart of the west of the City when the service opens its doors in November.”




Notes to editors:

  • * The Adelaide Health Centre, Millbrook is the new name for the building previously known as the Western Primary Care Delivery site and is based on the Western Community Hospital site. The Adelaide Health Centre is due to open in November 2009 and will benefit the local community by providing a wide variety of primary care services offering extended hours, seven days a week.
  • 83.3% of Southampton GP practices are currently offering extended opening hours for patients.
  • PCTs can enter APMS contracts with any individual or organisation that meets the provider conditions set out in Directions. This includes the independent sector, voluntary sector, not-for-profit organisations, NHS Trusts, other PCTs, Foundation Trusts, or even GMS and PMS practices. If PCTs contract with GMS / PMS practices via APMS, the practice would hold a separate APMS contract alongside their GMS / PMS contract
  • NHS Southampton City is responsible for investing in health and care services to effectively meet the needs of the City’s population.
  • Southampton Community Healthcare provides a range of community-based health services which enables patients to receive excellent quality care in the most appropriate setting.


For more information please contact Matthew Butler, Press Officer, on 023 8029 6930.


Southampton Community Healthcare

Southampton Community Healthcare (SCH) is the Provider arm of the PCT which provides community health services throughout Southampton and in parts of Hampshire.  SCH’s vision is to be the best provider of community healthcare services locally.

We are currently on the journey to become a separate organisation and our plans are outlined in our Integrated Business Plan for 2009-2014.  Southampton Community Healthcare (SCH) is proud to be the main provider of community health services to nearly a quarter of a million people in Southampton city.

We also deliver a range of services to neighbouring areas covered by Hampshire PCT and a further 335,000 people.

We employ around 2,000 staff (around 1,250 whole-time equivalents). For 2009/10 our forecast annual turnover is £82.6 million.

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Competition panel looks at NHS provider shift

Posted on May 28, 2009. Filed under: Arm's length providers, Journals | Tags: |

Health Services Journal | BY HELEN CRUMP | 27 May 2009

The co-operation and competition panel is to investigate plans to transfer a primary care trust provider arm’s services to a foundation trust.

The co-operation and competition panel is to investigate plans to transfer a primary care trust provider arm’s services to a foundation trust.

The proposal to shift Barking and Dagenham PCT’s community health services to North East London foundation trust for two years will be the second case to be investigated by the panel, which started work in January.

The combined turnover of the two organisations will be more than the £35m threshold for community service providers at which an assessment is required.

Whether provider arm mergers are anti-competitive is as yet untested but half of PCTs hope to merge provider arms.

Panel director Andrew Taylor said: “Everyone’s going to be paying close attention to see how we deal with it.”

The Department of Health will carry out a “major review” of its principles of co-operation and competition in the summer.

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Commissioner-provider divide

Posted on May 27, 2009. Filed under: Arm's length providers, GP-led health centres, Journals, Polyclinics, Social enterprise | Tags: |

Health Service Journal |YOUR IDEAS AND SUGGESTIONS | 26 MAY, 2009 | UPDATED: 28 MAY 2009

By Mark Johnson, managing director of specialist public services law firm TPP Law (

Primary care trusts are facing some critical issues over the integrity of local services as they separate their commissioner and provider functions.

All PCTs must have ensured their provider services arm has moved into a contractual relationship with their PCT commissioning function using the new Standard NHS Contract for Community Services by April 2009. The degree of separation must be sufficient to avoid potential conflicts of interest.

In addition, by October 2009, all PCTs must review the operations and governance of their provider services arm to ensure it is the most appropriate form to suit local needs and to declare whether or not they are interested in establishing a social enterprise or community foundation trust for any services and agree a plan with their SHAs for their future development and management.

They must also produce a detailed plan for transforming community services which reflects their future shift to becoming world class commissioners focused around the needs of the local population and the opening up of local markets to competition. This competition is seen as key to driving up standards and improving efficiency.

Undertaking separation will require considerable resources and time – but the unprecedented and detailed review of services this entails should be a very instructive exercise, which will improve customer focus.

There is no prescribed formula for separation: it is a matter for local determination. The options for externalisation range from creation of an arm’s length organisation which remains legally part of the PCT, to creating a new organisation that exists outside the PCT, such as a social enterprise or a community foundation trust; or one which exists in alliance with another organisation or through vertical or horizontal organisation with another provider, such as an acute foundation trust seeking to extend its income from payment by results, or another PCT provider arm respectively.

There are also private sector organisations interested in partnering with PCTs to provide clinical and back-office support, as well as working capital and access to technology.

Provider arms are usually very diverse business units containing a variety of services, ranging from community nursing, older people’s services, specialist therapies, as well as urgent care, to children’s services and sexual health.

There will be no ‘one size fits all’ formula for divesting services. Rural areas will require different solutions to urban areas. In the organisations we have assisted, a mixture of partnerships with other agencies, social enterprise and the voluntary sector have all been feasible options.

In deciding which way to go, avoid creating structures of Byzantine complexity: fragmentation can easily bring a loss of ethos and values and hit staff morale. Any part of the business unit wanting to go it alone must be a viable and sustainable business in its own right. This may imply a preferred supplier contract for the initial years.

Separation will bring some important challenges. There may be change fatigue if the workforce has just undergone reorganisation. New organisations need the right leadership and management skills. In many cases this will come from outside the existing PCT board. New skills such as marketing, raising finance and cashflow management are needed.

PCTs must consider how separation and the consequent loss of control will impact on their ability to implement innovation in care pathways and integrated services. Losing a large section of the workforce into the provider organisation could expose skills gaps in the commissioning arm. Will it be acceptable for some staff to straddle the divide?

Separation will also create tension. Solutions must be locally determined, taking service users along with them; form must follow function. A detailed project plan plus clear processes around information-sharing and confidentiality will be required. The scope of authority and powers delegated to the provider arm must be transparent.

The basis of charging for services will be critically important. This may be the first time that individual services have been rigorously costed.

The absence of national tariffs for community services in the short term will be problematic. Workforce issues, particularly around the transfer of NHS pensions and TUPE rights, require special care.

Successful provider organisations will need high standards of leadership and governance, strategic planning and financial control. To win patient trust and confidence, they will need to display a clear set of values and engage effectively with their local population. The challenge is there to be taken up.

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David Colin-Thomé on commissioning in the NHS

Posted on May 6, 2009. Filed under: Arm's length providers, Journals, Social enterprise |

Health Services Journal | 6 May 2009

David Colin-Thomé talks about the principles behind keeping providers at arms length from primary care trusts

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‘Three visits and you’re in’ at Darzi centre

Posted on April 22, 2009. Filed under: Arm's length providers, GP-led health centres, News stories |

Pulse | By Steve Nowottny | 27 March 2009

Patients who attend a GP-led health three times as walk-in cases will automatically be offered registration, even if they already have a practice, Pulse can reveal.

Dozens of the new centres are due to open around the country next week and will begin recruiting patients from across wide catchment areas.

But it has emerged that in at least one area, PCT managers are going further – and have made offering frequent walk-in attendees registration a contractual requirement.

The move has generated controversy in Doncaster, south Yorkshire, where the PCT provider arm and some local practices will run a new GP-led health centre in the town centre.

It has prompted neighbouring GPs to launch a poster and leaflet campaign, alerting patients to the full ramifications of switching practice.

Dr Dom Patterson, a GP at the Burns Practice which will be just 400 yards from the new health centre, said GPs were told at a local educational meeting that ‘if patients visit three times they’ll be invited to register with the 8-8 centre’.

‘That was met with quite a lot of disgust from a few of the local practices not involved,’ he said.

An NHS Doncaster spokesperson said: ‘The specification requires the 8-8 provider to have processes in place to recognise when the bulk of care for an unregistered patient is being provided through the 8-8 service. A patient attending on three consecutive occasions was used as an example.

‘If this situation arises they must engage with the patient to explore whether registration with the 8-8 service might improve the patient’s experience and provide better clinical management.’

Dr Rosie Hamlin, secretary of Doncaster LMC, said the committee had been unaware of the contractual clause and was likely to coordinate a wider poster campaign to warn patients in practices across the town.

‘The whole point of the 8-8 is that it is extra and isn’t replacing – and this almost appears to be replacing,’ she said.

‘The concern is that they have to have a positive conversation about registering and that this is in the contract. That’s something completely different to patients being aware they can register if they wish.’

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PCT boards risk governance failure over provider organisations

Posted on April 18, 2009. Filed under: Arm's length providers, Journals, Providers |

Health Services Journal | 9 APRIL 2009 | BY HELEN CRUMP

Primary care trust boards risk failures in governance because arrangements for appointing the boards of their arm’s-length provider organisations are unclear.

The NHS Confederation is calling for provider arms to be treated like wholly owned subsidiaries of private companies.

The Department of Health’s rules say PCTs should set up separate governance arrangements “so the provider service is treated like any other provider”, but the commissioning PCT board remains ultimately accountable for the provider’s activity.

This means provider arms cannot make public appointments to boards. As a result it becomes difficult for them to prove that board members have the skills and capacity to make robust decisions.

PCT Network director David Stout said: “The worry is, particularly in light of Mid Staffs, if things go wrong and people ask questions about governance, it’s going to come back to ‘we didn’t have a proper system in place’.”

He said: “We’re arguing you should be able to have the same quality of process for appointing the provider arm [board] as anyone else is allowed. Patently it’s problematic not to be able to do that.”

Lawyers say PCTs still struggle to make sure arm’s-length provider boards and PCT boards have the right systems in place to protect themselves.

Intervention orders

Capsticks senior partner Peter Edwards said: “If these problems are identified and haven’t been addressed and identified by the accountable board, there is scope for intervention orders from the secretary of state and everything that flows from that.”

He said managers must make sure enough information gets to the PCT board and the provider board and that the PCT board gets to exercise “the right degree of challenge”.

“From what I’ve picked up in discussions people are finding that very difficult to reconcile at the moment,” he said.

Some PCTs were appointing PCT non-executive directors to provider boards to ensure the legitimacy of board members could not be challenged, he said.

Cambridgeshire Community Services chief operating officer Matthew Winn said it was essential there was a “specific and robust” scheme of delegation from one board to another.

A DH spokesperson said it was working with the Appointments Commission on guidance to be published shortly.

HSJ’s NHS Governance 2009 conference is on 25 June. For details visit

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Middlesbrough and Redcar & Cleveland PCTs

Posted on April 17, 2009. Filed under: Arm's length providers, Social enterprise |

Langbaurgh Commissioning Plan

For 2008/09 it is receiving support from Langbaurgh Social Enterprise (a company governed by local practices and the community and funded by general practice) in developing its commissioning capability. In future Langbaurgh Social Enterprise is planning to split into two separate social enterprises, one being exclusively a commissioning social enterprise and the other to deliver local services possibly through a community interest company.

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