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Leading foundation trusts explore moves into primary care

Two of the most powerful acute and tertiary trusts in the country are looking to expand into providing primary care to establish vertically integrated provider organisations, HSJ has discovered.

The chief executives of University Hospitals Birmingham and Newcastle Upon Tyne Hospitals foundation trusts have both revealed they plan to take over primary care providers in their cities.

Dame Julie Moore, chief executive of the Birmingham trust, said she had been approached by GP practices regarding possible takeovers. “We’ve had a couple of large practices come to us to talk about merging with us,” she said, but she would not identify them because negotiations were ongoing.

She added that smaller GP providers had also been in contact, and said: “We’re always interested in looking at any which way we can improve patient care across a continuum.”

Dame Julie cited Newcastle Upon Tyne Hospitals as an example of a trust that had already moved into primary care.

The Newcastle foundation trust already runs a minority of primary care services in the city, through Freeman Clinics − a joint venture with local GPs set up in 2008. The three practices have varying ownership models − in two of them, all the GPs are salaried, while in the other, the practice’s income is shared between the trust and GP partners.

However, HSJ has discovered the trust wants to provide emergency services across the whole health spectrum, including out of hours primary care.

Its chief executive Sir Leonard Fenwick said: “Our ambition is to further address the model of vertical integration, and there is widespread discussion in Tyneside.

“As time goes by I foresee the city of Newcastle’s primary, secondary, community specialist and super-specialist under one umbrella. People are looking for a common pathway and cohesion - a national health service.

“This is not an overnight transformation. This change will not come about through a commissioning proclamation or a national policy statement. It’s step by step, building the confidence, and facilitating transition and investment where appropriate.”

Newcastle Upon Tyne Hospitals is already the community services provider for the city.

Sir Leonard said: “In Newcastle, there are only two constant factors: the city council and the foundation trust. All other aspects of the NHS are a moving feast. Bureaucracies come, bureaucracies go.”       

He emphasised the importance of joint work between his trust and Newcastle City Council, and said the local health and wellbeing board shared his ambition.

The comments come a week after HSJ revealed concerns from providers - including a major tertiary provider - had caused the delay of a high profile commissioner led integration programme in Oxfordshire.

Newcastle’s neighbour Northumbria Healthcare Foundation Trust also operates a joint venture community interest company with a local primary care provider, which runs consultations and minor surgery from a local GP practice.

Dame Julie said she thought structural change would best integrate acute and community care, in order to avoid arguments about which organisation should be paid for what work.

She argued single organisations would make it easier for patients to manage their care online and to build specialist teams, for instance based around diabetes patients’ needs, which best provided home based care.

But her comments were greeted with dismay by other parts of the Birmingham system.

Bob Morley, executive secretary of the Birmingham local medical committee, said the idea of a merger or takeover was “worrying”.

“It smacks of naivety and empire building,” he said. “It should be done the other way round, basing care on general practice and needs of patients.”

Andrew Coward, chair of Birmingham South Central Clinical Commissioning Group, said full vertical integration “would be a disaster” and “embraces a disease centred way of looking at life”, ignoring the non-acute sector’s focus on the whole person.

Tracy Taylor, chief executive of Birmingham Community Healthcare Trust, said: “We already have a single organisation covering primary, community, acute and tertiary care − the NHS.”

There was “little evidence nationally” that moving more care from hospital out into the community was easier in a single organisation, she said.

“In the main, what acutes see of community care is the element which interfaces with them, which is only 20 per cent of what we do… further structural reorganisation is not the answer. Even in large organisations barriers to working together can appear.”

Readers' comments (28)

  • This Sir Leonard chap's views really do come from the age of the dinosaur don't they?

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  • Hold on a second - one organisation running a whole healthcare economy? I have an idea - lets call it a health authority!

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  • This is definitely the way forward and would have the greatest impact on the increasing number of patients attending A&E departments. It is after all in the Trust's best interests to provide services in the community which patients choose to use instead of A&E departments. Primary care has singularly failed to do this.

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  • Claire Cater

    I think this makes sense where it works. This is surely a case by case basis. If I have learned one thing in the work we do, it is that relationships on the ground between organisations are what determine the success and failure of something. South Devon is a great example of this.
    So if they can make it work, this is great news for integrated services and learning. It's down to leaders and the front line staff working effectively together.
    I wish them every success.

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  • It was inevitable that hospital CEOs, used to measuring success by their power rather than the benefit they deliver to the public, should consider desperate means of maintaining their grip. But it's very hard to see that that is in the interests of local people. We're surrounded by evidence and experience confirming that patients need a proper primary generalist focus, integrated around them. The hospital expansionist model seems very unlikely to deliver that.

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  • At last the concept of a fully integrated NHS in England where all of the HCPs and Allied staff are employed by the NHS to provide a seamless service to patients. Not a Health Authority at all because budgets for Primary and Secondary Care were ring fenced. This is Integrated Care. The first step to one NHS?

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  • At last let success foster success - whole system approach - not a diminution of effective commissioning and choice. To the contrary full enablement of the Beveridge / Bevan ambition - a cohesive NHS! Go for it FT's.

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  • For practices 'owned' by FTs, won't there be a conflict of interest in their role as commissioners of secondary care? And potentially an associated weakening of the independence of their CCG?

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  • Structural integration between organisations in localities is a red herring which raises hackles about empire-building and who is calling the shots. Focus on the patients, the pathways and building the right relationships and integration of care delivery (not structures) will follow. There is as much fragmentation within single, large and overly diverse organisations as between them, so leave the structural dabbling to the politicians.

    Acute providers should be focusing their energies on the other story in today's HSJ about buddying up between themselves to support the delivery of excellent acute care across larger geographical footprints than the traditional DGH

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  • Anon 12.49
    Stop reading the Dail Wail,primary care consultation rates have risen along with everyone else the difference DOH doesnt throw money at it every time winter comes along , in fact comparative resource in primary care has dropped by 20% over the last 9 years.When a patient goes through to a+e for whatever reason an invoice is produced yet still more 'winter' monies are thrown at them.

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  • One type of health care missed out on Sir Leonard's list: mental health. Plus ca change. I suppose the local mental health FT is just a bureaucracy as well? It is about time NHS England gave local commissioners some backing to take on these dinosaurs.

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  • Robin Hood

    You cannot but applaud those Shelford movers and shakers. My merry men are reporting in that Prince Simon is already positioning his recovery gang and is right behind those who really do count. Power to the People !

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  • Conflict of interest does not apply . The NHS consitution is upheld. GP's are service providers and it is for CCG's and their successor bodies to place the contract and manage the orders. From what I understand the Newcastle FT has been in this business already for some five years and has a track record of achievement. Power to the people !

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  • Why not integrate? In our local A&E we had minor injuries treated by a GP and those minor issues triaged by nurses, leaving the emergency department to real emergencies. patients do not care which organisation employs/funds the service as long as it is fully accessible, safe and appropriate and delivered with sensitivity and compassionate competence. the rest is is just distraction.

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  • Ed Macalister-Smith

    This has to be worth a try doesn't it, as long as the focus is on patient benefit.

    Yes, the conflict of a primary provider inside an integrated provider also being a commissioner would need to be dealt with, but that's manageable.

    Let's do some pilots, with proper and comprehensive prospective evaluation, and see whether this works.

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  • Can someone please explain to me what prospective evaluation is...?

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  • Keep up,,,! North Essex Partnership University NHS FT is already running three GP practices in South Essex.

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  • I have a significant concern here. Even if you ignore the conflict of interest that applies in terms of commissioning. Birmingham is a big City with 3 Acute Trusts within its boundaries along with the likes of the Royal Orthopaedic. Recognising that UHB is a state of the art hospital, If I am a patient of a GP employed by UHB, what chance do I have of ending up under the knife of a surgeon at HEFT or SWBH with better clinical outcomes.

    I know GPs rarely exercise this power but the one thing you would hope as a patient is that your GP will act as your advocate and support you towards the best outcomes and Consultants available. What chance here?

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  • Sounds a little like Kaiser Permanente. Sharing a bottom line might make a lot of sense for patients.

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  • Sadly yet another HOSPITAL based solution, VERTICAL integration ? How about HORIZONTAL CARE PATHWAYS integration starting with the LA integration joint commissioning of out of hospital care ?? NHS remake will not do and this is an NHS centric conversation, can we please make a step change in thinking here.

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