Community providers have urged Monitor to support the development of new payment systems which will take investment away from the acute sector.

In a submission to the regulator’s provider landscape review, shared with HSJ, the NHS Confederation’s Community Health Services Forum called for a “deliberate journey” away from acute provision, with “increased investment in the [community] sector matched by the development of new capacity and services” led by community providers.

The forum, which represents the views of over 50 community and acute trusts, social enterprises and independent providers, said a mixed and flexible payment system was needed using payment by results, block contracts and new style payments such as whole year of care tariffs.

With no realistic prospect of increases in NHS spending, the forum said: “It will be vital to find safe and sustainable ways of taking resources from elsewhere to invest in the increased community-based capacity that is clearly needed.”

“Local leaders will need to be brave, especially where the need to shift resources to provide care differently creates losers.”

But the forum warned “it will take several years to develop both quality data and new payment mechanisms.”

In its submission the forum said care should be designed around population need rather than the configuration of buildings and called for Monitor to be “visionary” to identify how the balance can be shifted.

The forum has argued for longer-term contracts for community services of between three and five years to allow “time and space” for service change and investment.

It said the system needs to be outcomes based with incentives concentrating care in the acute sector removed and replaced with those encouraging integration and community provision. The NHS workforce also needs to be better equipped to work across organisational boundaries.

Work has already started to develop performance indicators for community providers which could eventually underpin a payment model.

Michael Scott, chief executive of Norfolk Community Health and Care Trust and chairman of the NHS Confederation’s Community Health Services Forum, told HSJ: “This has been rhetoric for many years and yet it hasn’t happened. We are getting to the point now where it has to happen.

“This isn’t special pleading on behalf of community providers. Patients and the NHS need this change.

“Patients prefer care in the community, it is more cost effective and it suits the demographic disease profile we are now dealing with.”

But he warned: “We need a payment system which reflects the diversity of community services. Developing a community tariff will take some time.”