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.”