Harmoni merger with Thamesdoc

Posted on January 27, 2010. Filed under: GP-led health centres, Press/News Releases, Providers | Tags: , , , |

Harmoni website | accessed 27 January 2010

Harmoni is delighted to announce that Thamesdoc GPs have voted unanimously in favour of their Board’s recommended merger with Harmoni.

Stephen Price, Chief Executive of Thamesdoc, said “The recent Care Quality Commission interim report highlights the importance of delivering a high quality service where patient care and patient experience are the top priority. We believe that this adds further weight to the move for Out of Hours providers to consolidate in order to have the scale to deliver the best patient care. Thamesdoc and Harmoni are a natural fit. We share common roots as GP based Co-Operatives, have a good fit culturally and are geographically adjacent. I am confident that this merger will enhance the ability of both organisations to deliver high quality care to the populations we serve”.

Andrew Gardner, Harmoni’s Chief Executive, said “This merger reinforces Harmoni’s position as the market leader in the provision of Urgent Care services in England, and further enhances our ability to invest in the people, infrastructure, systems and processes required to provide the best possible patient care. We will set up a new Region based on the South East Coast Strategic Health Authority geography made up of the two companies existing services in Surrey and West Sussex and targeting the new opportunities that are emerging across the rest of the SHA. We will retain the Thamesdoc brand in Surrey where it is well respected and continue to use the Harmoni brand elsewhere.””

Harmoni is a leading provider of primary care services to more than 6 million patients across England. Its services are commissioned by over 20 NHS PCTs and include Out of Hours services, GP led Health Centres, Urgent Care Centres, Single Points of Access and Admission Avoidance schemes.

Thamesdoc is a GP co-operative providing Out of Hours and other urgent care services to patients in Surrey and parts of West Sussex and Hampshire.

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The nuts and bolts of setting up a social enterprise

Posted on November 16, 2009. Filed under: News stories, Social enterprise | Tags: , , , , , , |

Pulse | 16 November 2009

Emma Wilkinson takes a look at what social enterprises can do for PBC

What is a social enterprise?

Social enterprises are businesses, but unlike limited companies that make profits to line the pockets of shareholders, they are driven by environmental or social principles, and surplus funds are reinvested to further those goals. So the community benefits from any profits made.

The Social Enterprise Coalition (www.socialenterprise.org.uk) says there are some 62,000 social enterprises in the UK with a combined turnover of at least £27bn.

Mo Girach, social enterprise lead for the NHS Alliance, says: ‘There are three elements to social enterprises. They are designed to tackle social objectives, such as health inequalities. Any profits made are reinvested in the local community. And local people and staff have the ownership of their services.’

If you generate the bulk of your income from trading and use most of your profits to further social or environmental goals, your organisation might be classed as a social enterprise.

Models for a social enterprise include:

• A community interest company (CIC) – a legal form created specifically for a social objective, overseen by the CIC regulator to ensure it does not deviate from its mission and that its assets are protected (www.cicregulator.gov.uk).

• Industrial and provident society (IPS) – this is the usual form for co-operatives and community benefit societies, and is democratically controlled by members.

• Companies limited by guarantee or shares – these can have a social mission written into their memorandum and articles of association, but are not regulated.

• Group structures and charitable status – in these cases the tax breaks associated with charitable status can be an important factor.

How do they differ from a limited company?

The key difference is that a social enterprise is set up to fulfil a social goal rather than a financial goal. But social enterprises are businesses and need to make a profit to be competitive, remain afloat and to keep investing in their social vision. They are not an easy option for someone wanting to avoid the legal technicalities and governance arrangements of a limited company.

Dr Mike Dixon, chair of the NHS Alliance, says: ‘It’s a way of setting out business principles but making sure the business is there for the patients and not for shareholders.

‘The steps to setting one up are similar to those for a limited company – you need a lot of advice, you need to decide your basic vision and what sort of partnership it’s going to be, and who is going to be a part of it.’

Mr Girach adds: ‘A true social enterprise has in its constitution that profits are reinvested and there are no shareholders. That is a key point. There might be shareholders but that is in terms of ownership rather than profit so they are more social enterprise members.’

What are the advantages for PBC?

Setting up a commissioning group under a social enterprise model means GPs are less likely to be accused of lining their own pockets – a suggestion that has surfaced repeatedly in the past few years. It may also be an easier route for organisations wanting to work as both provider and commissioner.

Dr Dixon explains: ‘It shows that the profit motive is not an issue but at the same time gives a businesslike approach.

‘There’s another element that’s quite important if you are a commissioner.

I think it allows a certain blurring of boundaries when it comes to also having a provider role.

‘Social enterprises are becoming more common in PBC – not rapidly but PBC has been a slow process – and they are very logical.’

Richard Oliver is business manager at Nene Commissioning, a not-for-profit community interest company of 76 practices in Northamptonshire that started life as a limited company.

‘Trying to get 76 practices under one umbrella is a challenge and there was a huge amount of discussion about the structure that might be suitable. We started off as a limited company because it was a known legal entity but we decided that didn’t reflect why the organisation got together. So we looked around to see how we could demonstrate it wasn’t just a money-making exercise for doctors but that it was about patients.

‘The model that most clearly suited what we already had but that could move us into the social enterprise arena was a community interest company. We retained nominal shares and there is limited liability but at the same time the money is retained for use in the business.’

Any disadvantages?

Disadvantages to being a social enterprise may have more to do with misconceptions surrounding their function rather than a problem with the business model itself.

‘I think people don’t understand the calibre of credibility and true benefits they bring and think they’re small businesses,’ says Mr Girache.

‘The other problem is commissioners don’t embrace social enterprises and tend to go with what they know, for example the foundation trust, which are mutuals.

‘There is a lot of work to be done between commissioners and providers in raising awareness of social enterprises. This is something the Department of Health’s social enterprise unit is working on.’

Dr Dixon agrees: ‘A lot of people see social enterprises as rather woolly and something done by people in socks and sandals rather than business suits, but that’s not true and there are lots of examples of successful social enterprises. Look at John Lewis.

‘The other thing is that there are people in social enterprises who are not as they seem. It is easy to be a wolf in sheep’s clothing. If it does take off we will have to look very closely at social enterprises and check people are who they say they are – not one thing masquerading as another.’

Why has the government been so keen on social enterprises?

It is not just the current government that is keen on PBC groups setting up social enterprises, with the announcement of a £100m pot for health and social enterprises in 2007. The Conservatives have also hinted they may be the way forward, with talk about social responsibilities as well as a focus on the ownership agenda.

‘I think there are a number of reasons the Government is keen on social enterprises,’ says Mr Girache. ‘The ownership factor is a big reason. Being able to say to people “over to you – deal with it”. There is an incentive for people to get a little bit back and also a feeling that in some policy areas, such as health inequalities, things haven’t moved. PCTs have been working on these for 20 years and sufficient progress just hasn’t been made. Social enterprises are an alternative.’

So what are the first steps in setting one up?

Nene commissioning’s Richard Oliver says the first thing to do if you are interested in setting up a social enterprise is to make sure the PCT is on board with the proposed change. Then you need to decide what kind of organisation you want to be.

‘Do a lot of preliminary work before you see a solicitor as there is a lot of information out there, for example on the Social Enterprise Coalition website, to inform your decision. Then you need to get legal advice, and I would recommend choosing a solicitor with national experience.’

Dr Mike Dixon adds: ‘You need to form the right relationship first before you do anything else. There is no point hoping to gel with practices that don’t talk to each other.’

Are there any pitfalls?

With the appropriate business and legal advice and a clear plan of what the company wants to achieve, the process should be fairly straightforward, but there are potential problems to consider before taking that leap.

‘People often think social enterprises are not businesses but a form of charity that doesn’t have to make a profit – this is nonsense,’ says Mr Girache.

‘You need to think who your competitors are and what you have over them. Social enterprises focus on quality rather than feeding shareholders’ pockets.

‘The other thing is to do proper market research. You will have to deal with some aggressive providers and if you don’t understand the market and what your niche is, you will fail.’

Dr Dixon advises: ‘Don’t expect organisational form to be the solution to everything and don’t be too optimistic about what you can achieve; be realistic.’

Mr Oliver adds: ‘When it comes to legal advice, make sure you only fund what you need to as you can incur a lot of costs.’

What about funding?

To get off the ground, in addition to PCT resources, there are various sources of funds for social enterprises, including patient capital, grants and favourable loans, details of which can be found in the Good Deals 2009 Social Investment Almanack.

In June 2009, Social Investment Business took over the management of the DH’s social enterprise investment fund, and along with Partnerships UK is responsible for the £100m fund (£70m is now left) for start-up and existing social enterprises in the health sector over the next three years.

But the NHS Alliance would like to see more incentives to catalyse the social enterprise model.

Dr Dixon explains: ‘There are sources of funding available, for example from the social enterprise unit at the DH, but we produced a report three or four months ago pointing out there should be preferential treatment for people funding social enterprises in the form of tax advantages, the ability to get capital and VAT relief, in order to make social enterprises build a bit faster. It needs to be pushed further.’

Richard Oliver says: ‘Our funding comes through the PCT like any other PBC cluster and is based on population size – which for us is 650,000.

‘The advantage of being so big is that our money is pooled so we can fund a team working on our behalf rather than having to do it ourselves in house.

‘We looked at it and realised there was no way we were going to be able to do that and the day job of looking after patients, but by pooling the resources we can have a much bigger team – there are 10 people here – running the PBC side of things.’

Emma Wilkinson is a freelance journalist

More information

The Third Sector has published The Social Investment Almanack to showcase the different types of social investment.

It includes a comprehensive directory of social investors, finance providers and support organisations as well as many examples of different models.

Good Deals 2009: The Social Investment Almanack

http://www.socialenterpriselive.com/supplements/good-deals-2009-the-social-investment-almanackGood Deals 2009: The Social Investment Almanack


Focus on… social enterprise

Pulse | 13 November 2009

This month’s Focus on… looks at social enterprise models and what they can do for PBC. Here, Rebecca Chaloner outlines the Department of Health’s commitment to the concept.

Social enterprise models are about connecting with and investing in communities, empowering staff and working in partnership to deliver innovative services.

The social enterprise sector is diverse, with more than 6,000 schemes estimated to be delivering health and social care in the UK. This figure continues to rise as growing numbers of health and social care professionals investigate social enterprise as a viable option to tackle unmet needs and address health inequalities.

Sharing the same public-sector ethos as the NHS, social enterprises reinvest surpluses into services and the community and run on business principles that improve quality and efficiency.

Clinicians are committed to delivering high-quality patient care, and some may feel frustrated by a system and processes that restrict their ability to achieve the change they desire. Social enterprise, with its scope to innovate and be flexible to local need, is one way to empower clinicians to deliver care that is truly responsive to patients’ needs.

Social enterprise is not for everyone, nor is it for all services. However, it is an important option for those looking for a way to deliver a wide range of health and social care services as we move towards a more responsive, modern and targeted healthcare system.

Social enterprise is a way for PBC groups not only to support the commissioning of services but also to provide services in a way that enables them to address unmet local needs. It also offers the potential to forge a new partnership between professionals, users and the local community.

The Department of Health wants to ensure that social enterprises are in a position to add value to current services and that commissioners, through a range of providers, can offer choice and quality to patients, as well as value for money.

In line with its commitment in the NHS Next Stage Review, the department is encouraging the creation of new social enterprises to deliver primary and community services. To facilitate this, PCT staff have been granted the ‘right to request’ to set up a social enterprise from their PCT. This allows staff to explore setting up a social enterprise to deliver services if they believe that gaining the independence and flexibility will enable them to improve services and outcomes for users. The department is now working with a number of ‘right to request’ proposals and supporting them in developing their ideas to transform services.

The journey towards establishing a social enterprise requires determination and vision but there is support available through the £100m social enterprise investment fund (SEIF). The SEIF provides business advice as well as seed funding for start-up social enterprises and development loans for existing businesses. The fund is available to anyone in England operating, or wishing to start up, a social enterprise in health and social care.

The department is committed to supporting social enterprise as a way to increase social cohesion in communities, improve health and wellbeing and reach beyond traditional means of delivering care.

Rebecca Chaloner is head of the Department of Health’s Social Enterprise Unit



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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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Foundation trust pipeline is not blocked, insists DH

Posted on August 27, 2009. Filed under: Journals | Tags: |

Health Service Journal | By David West | 20 August 2009

The Department of Health has denied claims the foundation trust pipeline is “on hold” despite a significant slowing of authorisations. Last year, there were 25 authorisations between January and August; this year there have been 10. 1206002_Recycling_Station_Fotolia_Credit

Monitor has said it is concerned about the lack of applicants. Its executive chair Bill Moyes this week criticised the government for the slowing transition to an all-foundation system. At the present rate, this would not be complete until 2015, he told the Financial Times. He said reform had slowed when Alan Johnson was health secretary and, although Andy Burnham backed change, he had been focusing on swine flu.

The chief executive of one trust expected to begin the authorisation process this autumn said it was effectively “on hold” because of uncertainty about the impact of the recession. Oxford Radcliffe Hospitals trust acting chief Chris Hurst said trusts needed more certainty about future income to go into the process. It was difficult at present for any trust to know “with complete confidence” that their plans were secure, he said.

More clarity should come in the 2010-11 operating framework this autumn, said Mr Hurst. “Until [the NHS and Monitor] have those parameters… the pipeline is probably on hold for acute trusts.”

NHS East of England strategy director Stephen Dunn said: “We have had a degree of slippage and that is taking people closer to our cut-off deadline of the end of the year [to enter the pipeline]. We expect people to rise to the challenge.”

A Monitor spokeswoman said it understood it was “difficult” to plan at present but the NHS would be able to deal with investment cuts better if more trusts became foundations.

DH spokesman said: “The FT pipeline remains a priority and has not been put on hold. NHS trusts applying to be FTs have a clear framework… [for] their financial plans. The number of applicants has always varied quarter by quarter.”

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Foundation trust can acquire GP practice, regulators rule

Posted on August 10, 2009. Filed under: Journals | Tags: |

Health Service Journal | 10 August 2009

A foundation trust’s acquisition of a practice in Sunderland will not create conflicts of interest, the Cooperation and Competition Panel (CCP) has ruled.

The integrated care organisation (ICO) pilot will see City Hospitals Sunderland acquire the Church View medical practice to create a ‘vertically integrated’ healthcare system.

Organisations including the NHS Alliance have expressed concern that such a merger would represent ‘market capture’ – effectively enabling the foundation trust to generate cash by referring to itself.

But the CCP has said that the proposed merger will not breach current competition rules.

In his statement, director Andrew Taylor admitted there was a ‘risk… that those GPs will have an incentive to refer patients to their employing hospital.’

But he said he had been reassured by the measures the trust had taken to prevent conflicts of interest, and by the large number of alternative practices nearby.

‘The proposed merger will not impose any significant costs on patients or taxpayers by reducing the scope for patient choice or competition,’ he concluded, ‘and will allow the benefits that might be realised from an ICO to be explored.’


Should foundation trusts be allowed to run practices?

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Integrated care pilot to be investigated

Posted on June 17, 2009. Filed under: Integrated care, Journals | Tags: , |

Health Service Journal | By Sally Gainsbury | 16 June 2009

One of the Department of Health’s integrated care pilot schemes is to be investigated by the co-operation and competition panel to see if it breaches merger, choice and competition rules.

Under pilot scheme, City Hospitals Sunderland foundation trust plans to merge with a local GP practice. The merger would represent a case of “vertical integration”, which the DH has been wary of due to concerns acute trusts could use control of a GP practice to drive up the number of acute referrals.

DH competition rules, published in 2007, state that primary care trusts must seek permission from the department before contracting for “list-based primary care services” through a hospital provider.

The panel’s investigation will use the Sunderland case to test assumptions and concerns about vertical integration. In a statement, the panel said it would “assess the extent to which the integrated care scheme may limit patient choice in relation to the type of NHS-funded healthcare services provided by each [provider]”.

It will also assess any benefits the model brings patients and taxpayers.

The panel is inviting submissions from interested parties. The closing date is 26 June. The earliest date for the completion of the investigation is early August, with the possibility of it continuing until the end of November if the issues are deemed complex.

More on integrated care

Can integrated care usher in a new age of risk taking?

Integrated care heightens provider monopolies risk

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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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Potential bidders circle as first NHS trust goes up for grabs

Posted on May 28, 2009. Filed under: Journals | Tags: |

Health Services Journal | BY DAVE WEST | 28 MAY 2009 

Twenty-two NHS organisations, including one based 200 miles away, are vying to take over the first trust offered up for competitive takeover.

Foundations and trusts from regions including the North West and South West have expressed an interest in acquiring or merging with Bedfordshire and Luton Mental Health and Social Care Partnership trust, NHS East of England has confirmed.

The strategic health authority says the takeover is the first process of its kind and will establish a model for trusts not expected to achieve foundation status.

Managers are looking to foundations to take over poor performing or unsustainable trusts but HSJ has been told foundations are wary that such moves would affect their own finance and governance risk ratings. This would damage their standing with the regulator Monitor.

NHS East of England director of strategy Stephen Dunn said the NHS transaction manual and Monitor guidance gave some direction to the process. But there were “quite a lot of gaps that need to be filled in”.

“That is why the Department of Health is working with us to clarify some of the finer points of detail, and this can act as a model for future transactions,” he said.

He added Monitor would examine any deal’s effect on existing foundation trusts.

“The challenge for any organisation is to try to ensure that the deal that is done does not increase risk of a potential breach of its terms of authorisation [as a foundation].”

NHS East of England has set a deadline of the end of 2009 for all its trusts to become foundations and is looking for alternatives for others. It is waiting for the Treasury to approve a competitive tender to run Hinchingbrooke Health Care trust as a franchise, which would also be open to the independent sector.

Consultant and former government adviser Michael Macdonnell is working with trusts looking at potential acquisitions and mergers. He warned there was a “policy vacuum” surrounding the process and said trusts wanted assurance they would not be taking a big risk for little benefit.

“From a foundation’s point of view there are very few incentives, and there are few levers to force them to do it. They need a model on how to do it.”

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Integrated care will be tested by only 16 organisations

Posted on April 18, 2009. Filed under: Integrated care, Journals, Providers | Tags: , |

Just 16 organisations have made it onto the Department of Health’s integrated care pilot scheme.

The department had originally said it would select around 20 bids from more than 100 applicants.

Three strategic health authority areas – NHS South Central, NHS South East Coast and NHS West Midlands – have been left without a pilot scheme.

There were 36 organisations on the shortlist published last year, including bids representing all SHA regions.

NHS North East and NHS South West have four pilots each and the East Midlands, East of England and North West regions each secured two.

London and Yorkshire and the Humber have one pilot each.

A DH spokesperson said: “It was always intended there would be around 20 pilots.

“The chosen sites cover a range of diverse models, focusing on innovation and delivering an improvement in outcomes, quality and service user satisfaction.

“The selected sites provide an appropriate range and spread to conduct a robust evaluation.”

Pilot schemes

The schemes range from a primary care trust-led collaboration between GPs, public sector organisations and the third sector to improve dementia care for older people in Bournemouth and Poole to a scheme to help patients with chronic lung disease led by Northumbria Healthcare foundation trust.

Social care, the third sector and local authorities are also represented in pilot schemes.

Clinical areas include older people’s care, long term conditions, dementia, end of life care, cardiovascular disease, mental health and substance misuse.

The pilots were first proposed in Lord Darzi’s primary and community care strategy.

The announcement followed a King’s Fund debate where experts evaluated the lessons the NHS could learn from US healthcare, where integration is more established.

UnitedHealth executive vice president Simon Stevens, a former adviser to Tony Blair, said while it was important to create systems that were integrated through teamwork and infrastructure, no US integrated scheme was a local monopoly.

He said: “If you think about any of the leading integrated systems, there is a third party purchasing system.”

Sites selected by the DH from the shortlist of 36

  • Bournemouth and Poole PCT
  • Cambridge Assura LLP
  • Church View Medical Practice, Sunderland
  • NHS Cumbria
  • Cornwall and Isles of Scilly PCT
  • Durham Dales Integrated Care Organisation
  • Nene Commissioning CIC
  • Newcastle upon Tyne Hospitals foundation trust
  • NHS Norfolk and Norfolk county council
  • Northumbria Healthcare foundation trust
  • North Cornwall Practice-Based Commissioning Group
  • Principia – Partners in Health, Rushcliffe, South Nottinghamshire
  • NHS Tameside and Glossop
  • Torbay Care trust
  • Tower Hamlets PCT
  • Wakefield Integrated Substance Misuse Service

GPs to front integrated care pilot schemes

Pulse | By Nigel Praities | 1 April 2009

GPs will work with care homes, social services, acute trusts and charities to improve patient care under a range of pilot schemes to begin today.

The £4 million scheme involves 16 integrated care organisations in different areas of the country, focusing on health and social care professionals can work together to develop services for patients.

After 100 applications to run the schemes, the winning 16 pilots range from improving the co-ordination of end-of-life care, preventing cardiovascular disease and encouraging more self-care for people with long-term conditions.

The pilots begin today and will run for two years and will be evaluated for their effect on health outcomes, improved quality of care and service user satisfaction.

Health Minister Ben Bradshaw said this was an opportunity for patients to get all the health and social care they need in one place.

‘This programme provides an opportunity for clinicians – working closely with the community more widely – to use their on the ground knowledge to design services that are flexible, personalised and seamless,’ he said.

Integrated Care Pilots – Pilot Summaries

1. Bournemouth and Poole Teaching PCT

This pilot will be exploring a new model for delivering care for older people with dementia, involving collaboration between GPs, public sector organisations and third-sector services. It aims to provide a single point of access to an integrated community team.

2. Cambridge Assura LLP

This pilot will look at how different organisations across the health, social care and third sectors can better communicate and co-ordinate end-of-life care to enable people to be cared for and die in the place they choose. The pilot will also be improving public and patient engagement to ensure services are fully sensitive to user needs.

3. Church View Medical Practice, Sunderland

This pilot will improve quality of care and experience of services for the area’s population of older people. The local acute trust and GP practice will work together as an integrated organisation, and will work in partnership with the PCT provider arm, social services and the patient practice group. The pilot will aim to provide an improved, personalised experience through active management of long-term conditions.

4. NHS Cumbria

This pilot will be exploring a new approach to helping patients with chronic diseases to manage their own care. It will be focusing on increasing the collaboration between GP and patient. It will aim to move care into a community setting and reduce hospital admissions.

5. Durham Dales Integrated Care Organisation

This pilot will involve seven partner organisations working together to meet the needs of a rural population, provide continuity of care and reduce health inequalities. It will explore a number of different care pathways aiming to improve planning information, move care into a community setting, increase patient/carer satisfaction and reduce hospital admissions.

6. Nene Commissioning CIC

This pilot will develop new models of long-term condition management to help patients remain independent for longer and have more choice in their end-of-life care. It will create personalised care plans for high-risk individuals and aim to reduce admissions to hospital.

7. Newcastle Hospitals NHS Foundation Trust

This pilot will provide an improved preventative service for over 60s at risk of falling by broadening the current falls and blackout (syncope) service provision. It will enhance provision and access to care and establish a network of community-centred training services led by clinicians, in partnership with the third sector and other agencies. By developing these community services the pilot aims to reduce the number of falls and admissions to hospital.

8. Cornwall & Isles of Scilly PCT

This pilot will unite primary, secondary, health and social care services by setting up a GP-led memory clinic supported by a team of practice-based case managers and dementia care advisers. It will seek to increase the number of people receiving an early diagnosis, reduce admissions to hospital and care homes and see people maintaining independent living for longer.

9. NHS Norfolk and Norfolk County Council

The focus of this pilot will be on integrating care services for the elderly. Joint working between the PCT and the County Council will identify people in need of support and then work with them to develop personalised care plans. It aims to help elderly people live fulfilling and independent lives and to form care plans that meet the needs of both patients and carers.

10. Northumbria Health Care NHS Foundation Trust

This pilot will be exploring a new approach to helping patients with Chronic Obstructive Pulmonary Disease (COPD) to manage their own care. The pilot will ensure providers work together to co-ordinate care, provide consistent information and education and help patients manage their own care (with assistance from their key worker).The pilot aims to increase patient satisfaction, reduce hospital admissions and reduce the length of stay in hospital when admission is required.

11. North Cornwall Practice-Based Commissioning Group

This pilot involves 10 GP practices in North Cornwall working together to integrate Mental Health community teams, based in a rural location, with a single point of access from GP practices. It will integrate Mental Health acute and social services. The pilot will aim to dissolve boundaries so patients can more easily navigate through the system and ensure they ‘only have to tell their story once’.

12. Principia – Partners in Health, Nottinghamshire

This pilot is designed to help create more informed and empowered COPD patients. It will involve partners working together through two projects to identify ‘at risk’ patients, and work with teams in community wards and with other partners involved in COPD treatment to integrate care along the clinical pathway. It is designed to improve co-ordination of care, increase patient satisfaction and reduce hospital admissions.

13. NHS Tameside & Glossop

This pilot will be seeking to change behaviour amongst people at risk of CardioVascular Disease (CVD). It will involve developing partnerships to identify ‘at risk’ residents, supporting them with diagnosis/treatment but also promoting self-care and behaviour change. The aim is to reduce the risk of CVD (and reduce mortality rates for patients who have contracted it), improve the patient experience and reduce visits to Outpatient clinics.

14. Torbay Care Trust

This pilot will be integrating care for the elderly so that it is personalised and tailored to individual needs, secures best possible outcomes and ensures best use of resources. It will involve partner organisations across primary, secondary, social care and mental health services focusing on the whole care pathway, seeking to deliver high-quality, safe, and reliable services for patients across the spectrum of care.

15. Tower Hamlets PCT

This pilot will be helping patients with long-term conditions to manage their own care. It will help patients make their own choices, with support from a range of diverse services and specialists locally. It will aim to improve health and well-being for patients with long-term conditions, increase uptake of services from targeted hard-to-reach groups and reduce the expected trends in long-term conditions.

16. Wakefield Integrated Substance Misuse Service

This pilot will integrate care in the context of a substance misuse and social reintegration service for vulnerable people. It will involve a partnership of NHS, third sector and wider stakeholders and aim to make measurable improvements in the “care experience” for substance misusers, creating integrated pathways that are both personalised and cost efficient.

Pilots welcome as no one model of integrated care will work everywhere

King’s Fund Press Release | date: 01.04.09

Commenting in response to the Department of Health’s announcement today of new pilot schemes trialling the integration of different patient services including health and social care, The King’s Fund’s Chief Executive, Niall Dickson, said:

‘Bringing different services together in this way offers great potential for improving the quality of care patients receive. Too often boundaries between health and social care prevent people getting the care they need. Patients have to find their way around a complex system of doctors, community health workers and social care services when they should be able to talk to a single person about all their care needs. Some patients can end up blocking hospital beds when what’s best for them would be more support at home. And poor co-ordination between health services in the community and hospitals can mean unnecessary admissions and poor aftercare.

‘As more people live with long-term conditions, the challenges posed by chronic disease management and care planning will require services that are able to respond to the range of needs each patient has. Having a clear single point of contact for all services and ensuring better joint working between local health services and local councils should help people manage their conditions more effectively and receive more personal and convenient care.

‘The major challenge will be getting different health professionals – generalists and specialists, social care workers, community and hospital-based staff – to work more closely together. New and better types of care cannot be delivered simply by housing different professionals under one roof or merging multiple organisations. It requires bringing teams together, integrating the way staff work and creating new relationships between organisations.

‘It is also important that we do not create new monopoly organisations around the NHS that deny patients choice – we need services that are responsive and understand that either patients or commissioners may decide to go elsewhere.

‘It’s also important to recognise that there is unlikely to be one model that will work everywhere. That is why these pilots are to be welcomed but it is also why they will need to be thoroughly evaluated. The government has a habit of setting up pilots and then rolling out before lessons are learnt – that must not happen this time. This is a chance to learn genuine lessons about the best way to organise services.’

Notes to editors

  1. For further information or interviews, please contact The King’s Fund press and public affairs office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
  2. The King’s Fund is a charity that seeks to understand how the health system in England can be improved. Using that insight, we help to shape policy, transform services and bring about behaviour change. Our work includes research, analysis, leadership development and service improvement. We also offer a wide range of resources to help everyone working in health to share knowledge, learning and ideas.
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PCTs demand end to community foundation trust pilot

Posted on April 2, 2009. Filed under: Arm's length providers, Journals | Tags: |

Health Services Journal | BY HELEN CRUMP | 2 APRIL 2009 

Primary care trust provider arms are calling on the Department of Health to drop the community foundation trust pilot scheme and allow them to apply for foundation status on a level playing field.

Becoming a community foundation is one of the options in the DH’s transforming community services programme for provider arms, but only six are being piloted.

The other options open to provider arms, which account for £11bn of spending and a fifth of the NHS workforce, are the social enterprise model and remaining as a PCT provider arm.

But 95 per cent of provider arms interviewed by the NHS Confederation’s PCT Network shunned the social enterprise model, saying they preferred to remain within the NHS.

The PCT Network estimates half of provider arms are looking to merge with neighbouring PCTs’ community services and half of the merged organisations might want to become community foundation trusts.

A new monopoly

But last year NHS chief executive David Nicholson said he did not want to see community foundation trusts “reinventing a monopoly”.

And at an HSJ conference last week, national clinical director for primary care David Colin-Thomé suggested community foundations were only an option for the most “radical”.

PCT Network director David Stout said: “All the policy pressures are not to stay within the PCT, there isn’t any other option than one form or other of foundation trust.”

He warned against “getting obsessed by organisational form”, but added: “[DH director of system management and new enterprise] Bob Ricketts says there’s a cap in the number of pilot community foundations. We’re saying why do you need pilots?”

He called for “the lifting of any artificial barriers to community foundations”, saying the existing pilots were testing regulatory processes adequately.

Dr Colin-Thomé said the DH would not set “quotas” but provider arms would have to show they were large and high performing enough.

A DH spokeswoman said the six pilots were being assessed. She added: “This will identify any areas of clarification required by the DH and Monitor.”

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