HSJ can reveal details of a major review of healthcare across Greater Manchester which makes the clinical case for a radical redesign of services. It is believed this could prompt some leaders to argue for the removal of acute surgery from four hospitals.

Throughout 2012 NHS Greater Manchester’s Healthier Together programme has been working with clinicians and clinical commissioning groups across the city to gather evidence of a “case for change” in its health services.

The work has now been formally completed, and a paper summarising the findings will go to the primary care trust cluster’s board next week.

It is the first step in a process aimed at developing concrete proposals for reconfiguration in time for public consultation in spring 2013.

HSJ understands the review will indicate the need for significant service change in areas including cancer services, acute surgery and primary care.

A senior source familiar with the programme said its work on Greater Manchester’s cancer services had concluded that if their performance could be brought in line with the European average it would save 550 lives a year - roughly one for every GP practice.

A central problem, the source said, was that in four areas - gynaecological, urological, upper gastro-intestinal and hepato-pancreato-biliary cancer surgery - Greater Manchester was still not compliant with improving outcomes guidance which indicated these services should be concentrated on fewer sites.

Similarly, the “case for change” in acute surgery also suggests the need to concentrate services onto fewer sites.

The summary going to the PCT cluster’s board next week and seen by HSJ states: “Presently, emergency general surgery is carried out in 10 of Greater Manchester’s hospitals, but this service does not always have consultant staff present and admission to a critical care bed after surgery is not routinely available. This leads to inconsistent quality of care and poorer patient outcomes.”

The source said: “We’ve got too many sites providing acute surgery, we ought to be providing them on a much bigger footprint, probably half a million people [per site]. We’ve got to do something to rationalise our general surgery services.”

They added that the 10 sites currently provided acute surgery for a population of nearly three million people, suggesting that as many as four hospitals could need to stop doing that work.

Asked what this could mean for the number of accident and emergency departments in Greater Manchester, the source said it would be the “subject of clinical debate”.

The document also calls for action to “reduce the variation in primary care”.

“Delivery of enhanced and extended primary care outside of current working hours, such as that required to support end of life [care], will require a different way of working and collaboration across larger populations than that served by most GP practices.”

HSJ understands that the clinicians involved in this work are looking at a model in which GP practices work in federations to provide care outside normal working hours, and work out of larger premises to allow them to share back office functions. Under this model, primary care services would be open seven days a week, including public holidays, and for at least 12 hours a day.

The source said that the principle of this model would be to make it much easier for patients to see their GP, instead of going to accident and emergency departments. 

According to the NHS Greater Manchester board paper, over a quarter of A&E attendances in the region last year could have been treated at another suitable location. The annual cost of A&E attendances was £122m, and only two trusts received enough income from this activity to cover their costs.

The programme has also developed clinical cases for change in six other areas: urgent and emergency care, acute medicine, long-term conditions, women and children’s services, cardiovascular services and rehabilitation.