Published: 07/06/2002, Volume II2, No. 5808 Page 4 5

Two distinct roles for overseas healthcare providers are emerging from discussions being held between the government and US and European organisations.

According to government sources, US-based health maintenance organisations are most likely to be used as consultants to improve the performance of primary care trusts.

European healthcare organisations on the other hand will be encouraged to ease NHS capacity problems by staffing, and maybe developing, elective surgery units.

Health secretary Alan Milburn announced the plan to bring in clinical teams - in particular extra surgeons and other doctors - at last month's NHS Confederation conference (see Conference focus, 30 May).

But it is now understood that US providers Kaiser Permanente and UnitedHealth Group could be involved in test-bed partnerships with primary care trusts, aimed at improving information and management systems rather than directly providing care.

Discussions between the US organisations and officials from the Department of Health and Downing Street are under way, with the government likely to move by bringing together the US firms and interested PCTs.

In an interview with HSJ this week, Kaiser Permanente chief executive Dr David Lawrence says he is expecting 'a lot of questions' about training NHS clinical teams. Such work could focus on areas of Kaiser's expertise, such as asthma and diabetes.

National Association of Primary Care president Dr Rod Smith was enthusiastic about PCTs linking with US HMOs. 'I guess there would be some sort of contractual relationship with the PCT and Kaiser Permanente or another [HMO], ' he said.

And Rhidian Morris, a member of the NAPC executive and lead commissioner at South Hams and West Devon PCT, said: 'My PCT would like to move in that direction.

'We have discussed the Kaiser approach at our PCT executive.

We want to learn the lessons. That decision has already been made.'

Barbara Hakin, chief executive of Bradford South and West PCT and head of the national PCT development programme said there was already a lot of 'shared learning'with US providers. 'If we are moving towards some sort of compact, that would be a step beyond and would require very careful consideration.'

NHS Alliance chair Dr Michael Dixon said that moves to bring in US HMOs were 'a little bit premature'.

They were 'miles ahead' in IT, he said. 'But they're probably spending 20 to 30 times more on their management alone. I do not see why English managers and English clinicians can't figure it out. I do not think a bevy of US managers will help.'

Meanwhile, talks with European providers such as Germany's GerMedic and Sweden-based Capio are focused on providing more elective surgery. It is understood that capacity plans drawn up by strategic health authorities by mid-July will be used to identify areas where overseas providers could boost capacity for elective operations.

Chris Leworthy, director of NHS partnerships for Capio, which owns 21 private hospitals - formerly the Community Healthcare Group - in Britain, confirmed the company was involved in discussions.

Three options - overseas surgical teams working in the company's UK hospitals, working in NHS spare capacity, and working in a stand alone unit - were 'still on the table'.