STRUCTURE: A primary care trust chief executive has said he wants to see a local community services trust reach foundation status so there is a “big beast” to counterbalance the power of the acute sector in the East of England.

“We need a community provider who thinks itself the equal of the big acute foundation trusts,” said Norfolk PCT chief executive Andrew Morgan. “I want a big beast striding about the patch saying ‘I can look after people at home’.”

Norfolk Community Health and Care Trust is hoping for backing for its foundation bid at a board-to-board meeting with the SHA next month and potentially approval by Monitor next year. Its near neighbour Cambridgeshire Community Services Trust is also bidding to become a foundation trust - but has recently delayed its bid.

The bids are part of a rapidly evolving landscape of community providers across Norfolk, Suffolk, Essex and Cambridgeshire.  Unusually, there has been no vertical integration with acute providers - although mental health trusts have taken on services in some areas.

Instead, there are two aspirant foundation trusts, three substantial social enterprises and private company Serco is due to take over services in Suffolk by October.

An HSJ analysis examines how this new landscape is developing, the different strategies developed by the organisations, and asks whether this jigsaw of providers will change over the next year and beyond.