Negotiating change within PCTs is a tricky business. But with guidance and careful planning you can keep one step ahead, says Alexandra Jackson

Since January 2009, primary care trusts have been on a journey to reach an end state where they purely focus on commissioning. The plan was simple. Step one, split commissioning and providing activity and step two, transfer community services out of the PCT.

However, it has not been an easy process.

The creation of provider arms within PCTs raised concerns over confidentiality and conflicts of interest. The question of where such provider arms should be transferred has also been difficult: it has not been the case of one size fits all. Then there has been the requirement for plans to deliver the quality, innovation, productivity and prevention agenda.

Another factor has been tight deadlines. The revision to the operating framework for the NHS in England 2010-11 stated: “Separating PCT commissioning from the provision of services remains a priority. This must be achieved by April 2011, even if this means transferring services to other organisations while sustainable medium term arrangements are identified and secured.”

The revision also referred to a move towards an any willing provider model for community services in order to remove barriers to entry by the independent and third sector.

The story so far has been transforming community services (TCS). However, the white paper has broadened the scope of reform considerably, setting out the government’s strategy for a major transformation of the management of the NHS.

The proposal with the most impact on TCS is an apparent acceleration of the move towards an any willing provider model. Former PCT provider arms may have assumed they would have a soft landing in the market, with limited competition initially. This may not now be the case.

Another government proposal is the introduction of community service tariffs, which will see providers competing on quality and not cost. Provided the tariff is pitched at a financially viable level to allow participation for former PCT provider arms, these provider arms should have a competitive advantage over new entrants into the market, due to their lengthy experience in the delivery of community services and integration with existing NHS services.

So, even though provider arms will be operating in a competitive environment more quickly than anticipated, they should be well placed to compete.

Implementing TCS

To deliver TCS on time and as efficiently as possible, consider the following:

  • Early engagement of professional advisers is vital to avoid following a certain direction only to be informed that certain essential steps have not been taken. This can cause delay and can leave the entities involved exposed.
  • Consider using heads of terms, agreeing the main issues in principle between the transferor and transferee of community services, with the detail set out later in legally binding documentation. Such an approach can avoid delay and give the process direction.
  • Due to the deadlines involved, a balance needs to be struck between speed and quality. When implementing TCS, consider what the vital issues are. What is nice to have as opposed to essential? Also which issues are irrelevant and should be discarded quickly?
  • Is there anything that you expect you will be required to do which you could make a start on now? For example, what contracts does the provider arm currently have in place with third parties? Which staff are to be transferred? What property/other assets are required for the provision of community services?

There is a lot to be resolved and questions answered following publication of the white paper, which will have a significant impact on TCS. However, careful consideration will still need to be given to procurement issues and the need to satisfy the cooperation and competition panel on any proposed arrangements for PCTs to divest themselves of their community service provision.

It remains essential for PCTs to be alive to all the above issues when considering the options available to them in the healthcare market.