Collaboration gives “the advantages of scale that come with merger and acquisition without the downsides”

Major teaching hospital wants to share its 1300 consultants “across a wider network of hospitals”

District hospital retains its own board, own chief executive and full responsiblity for patient safety

District general hospitals around the country are looking to form closer partnerships with major teaching trusts nearby, according to one organisation pioneering such a model.

The hospitals are seeking to replicate the model which has been pioneered by Guy’s and St Thomas’ Foundation Trust with Dartford and Gravesham Trust, which involves close partnership but no formal merger

Susan Acott, chief executive of Dartford and Gravesham, told HSJ she had discussions with a number of trusts who were interested in learning more and potentially replicating the partnership.

Under the model, tertiary hospitals lend their specialists consultants to smaller local hospitals, giving district hospitals “the advantages of scale that come with merger and acquisition without the downsides”, she said.

“If you are a district general hospital within the sphere of influence of a big neighbour it makes sense to form a structured relationships with that trust,” Ms Acott told HSJ.

Ms Acott cited “West Suffolk Foundation Trust looking to Cambridge” or “Surrey and Sussex Healthcare Trust with the tertiary centre of Brighton” as possible examples of trusts who might benefit from such a partnership.

“It’s not about hospitals taking you over. It is about recognising you have a natural relationship and trying to make that relationship systematic and value added.

Guy’s and St Thomas’ Foundation Trust is one of four providers which was “accredited” last year by NHS Improvement to be a “foundation group leader”.

Consultants in paediatrics, cardiology and vascular, who are employed by Guy’s and St Thomas’, spend a day or sometimes two days, running clinics for patients in Kent.

The idea behind the vanguard has been to come up with a way of giving district general hospitals sufficient doctors to meet patient needs, within pressured budgets. It also aims to reduce unwarranted variation and improve clinical outcomes across a wider geographical area.

The scheme has been awarded £3m from NHS England’s vanguard fund for 2017-18 - £500,000 more than the current year.

Sarah Morgan, director of organisational development at Guy’s and St Thomas’, said it was becoming increasingly apparent that district general hospitals could not attract or fund sufficient medical consultants, with the vast range of specialist skills needed, on their own.

“At Guys and St Thomas’s we have 1,300 consultants working for us. We want to share our consultants across a wider geographical area.

“We could pull up the drawbridge. But that is not our values. Nor would it work. We couldn’t cope as a trust if our neighbouring trust fell over and all their patients came our way. It is about making sure the system as a whole works.”

Under the partnership, governance and accountability remain each trust’s responsibility: the boards remain independent, both trusts are answerable independently to the regulator and resident clinicians are responsible for patients treated in their hospital.