Healthcare leaders in Birmingham are already seeking to establish the new models of care provision proposed in last week’s NHS Five Year Forward View, HSJ can reveal.

The Vitality Partnership, a large provider of GP services across the city, plans to develop an integrated care organisation within a year.

The chief executive of University Hospitals Birmingham Foundation Trust has declared herself “very interested” in adopting the “primary and acute care system” form.

And Gavin Ralston, chair of Birmingham CrossCity Clinical Commissioning Group, has set out how it expects to “actively support” GP practices wanting to establish the multispecialty community provider model proposed in the forward view.

“[It is] no good coming up with a scheme that people are going to pursue reluctantly”, he added.

“It’s got to be something that your GP colleagues and their primary care team thinks makes sense.”


Dame Julie Moore is interested in providing more primary care in areas that have a shortage of general practice services

CCGs should offer financial incentives, support and advice to GP practices to encourage a move to the multispecialty community provider model, he added.

“Practices will fear the loss of autonomy that they have at the moment… [by] sharing responsibility with other practices.”

Sarb Basi, managing director of Vitality, said it would be a “natural, logical progression” to manage capitated budgets for health and social care budgets through an integrated care organisations.

Its first step would be to form a “coherent strategic partnership” with an acute hospital and work with community trusts to incorporate nursing and therapy services, he added.

Vitality was “not looking at running district general hospitals”, he said. “The expertise sits with those providers. What we will do is run community hospital type facilities and services in the community.”

University Hospitals Birmingham chief executive Dame Julie Moore told HSJ she was interested in the primary and acute care system form and enthusiastic about switching to capitated budget payment system – another key recommendation of the forward view.

The Birmingham FT was named by NHS England chief executive Simon Stevens during a radio interview as the kind of trust that could evolve into a more integrated provider of acute, community and primary care services.

Dame Julie said: “We would be very interested – we’re actually interested in all of the models [in the forward view] because you can see applications in a variety of settings.

“We’ve done a lot around taking dialysis out into the community… so I think that model is there. To say ‘build on it’ is a really good idea.”

She said she would be interested in providing more primary care in parts of the city that have a shortage of available general practice services.

However, this was likely to be “in partnership with some existing primary care setup” rather than independently, she said.

Last year, Dame Julie said she planned to take over some local primary care providers, although the acquisitions were never completed.

Gavin Ralston

The models must ‘make sense’ to primary care teams, Gavin Ralston said

She expressed support for the wider health system in Birmingham, including the “excellent” clinical commissioning groups and the Birmingham based Vitality Partnership, a scaled up GP provider also cited by Mr Stevens.

Dame Julie said she saw Vitality as a potential partner rather than a competitor, even though they were both evolving to become different kinds of integrated care organisations.

“There’s this belief that we’re all fighting and squabbling over work but actually there’s more than enough ill health and people needing treatment for everybody to do,” she said.

Asked whether she wanted to take on a joined up capitated budget to care for a cohort of patients in the community and prevent hospital admission, Dame Julie said: “Yes. Absolutely. Like a shot. Give it to me now.”

However, she said such an arrangement should only extend as far as specific condition pathways such as diabetes or chronic obstructive pulmonary disease, rather than covering an entire population in a local geography because “you have to think about specialised commissioning separately”.

Dame Julie revealed that she had been in talks with NHS England when it was first set up about piloting a year of care tariff, but the plan stalled after the departure of former policy director Bill McCarthy.

She also argued that Monitor should ask questions of any acute sector chief executive in a challenged health economy whose trust has a large cash balance.

“You have to be investing it back – that’s what we’re here for. I can’t believe any chief executive worth their salt will just want to sit on a pile of money and not use it to invest in healthcare,” Dame Julie said. “That would be well out of order, and needs a good look at.”