An acute provider and a community health trust are likely to compete to be the lead provider of services for the frail elderly under planned changes to contracting in Oxfordshire.

HSJ’s latest Local Briefing examines plans to introduce “outcomes-based commissioning” in the county for frail elderly, adult mental health and maternity services.

Although plans are still at an early stage, Oxfordshire Clinical Commissioning Group has outlined plans to enter into “competitive dialogue” to find either a lead contractor or a “specialist integrator” for frail elderly services.

One well placed source in the area told HSJ they expected Oxford University Hospitals Trust and Oxford Health Foundation Trust to compete for the contract.

Oxfordshire spends £215m a year on health and social care for frail elderly people. Each trust currently receives about a quarter of that sum. A third goes to Oxfordshire County Council.

It is thought likely that the winning bidder would bring in partners or subcontractors from the private or voluntary sectors, which would be better providers of some services, helping meet some outcomes. In the case of services for frail elderly people, whichever trust became the lead contractor would still be likely to use the other to provide some services.

Although commissioners have said they will test the possibility of bringing in a lead contractor from outside the county, it is acknowledged this may not be effective.

Under the new contracting model, providers would be expected to deliver a set of service standards related to patient outcomes. Some of these as currently set out in an early stage report produced by Oxfordshire CCG include patient experience measures, cutting the time spent in hospital, and reduced rates of admission.

Failure to hit the specified outcomes could cost providers around 10 per cent of the contract value.

Phase one of developing the outcome based commissioning project is now complete. Phase two will involve more detailed analysis, and is intended to produce a final list of outcomes, with performance measures which providers are expected to deliver.

Phase three will include a formal procurement process.

Local health leaders currently hope maternity and mental health services will move to outcome based commissioning by 2014-15.

However, it is expected that the model will not be adopted for frail elderly services, which are more complex, until 2015-16.