Integrated care pilots will be given the chance to shape Department of Health policy up to and including tariff reform, the primary care czar has revealed.
Speaking as the DH revealed the 36 organisations shortlisted for the scheme, national clinical director for primary care David Colin-Thomé said the organisations making the final cut would be at the forefront of radical trials of reforms perhaps 'too risky' to be introduced across the board. Those that worked could become policy, he said.
In "exceptional circumstances" the DH would consider postponing or stopping current system reform work. It could even contemplate different funding formulas suggested by pilots, he added.
The initiative is the first major attempt by the DH to kick-start the locally led service redesign promised in health minister Lord Darzi's next stage review. Dr Colin-Thomé said the initiative "underpins all our hopes of where we want the health service to go" but warned the onus would be on managers and clinicians to make schemes work.
"This is one of the most innovative things we've tried for a long time in the NHS… At primary care trust level, but also amongst the service, there are areas that haven't been as progressive as others. In some places, clinical leadership hasn't been imaginative."
The shortlisting process has attracted some criticism because PCTs had just weeks to select and put together bids. Oliver Bernath, managing director of GP partnering organisation Integrated Health Partners, said the timescale should have been longer to enable plans to go before boards.
"Clearly the department doesn't reflect PCTs' internal processes in its system design," he said.
Plans in the pipeline
East and North Hertfordshire PCT chair Pam Handley said her organisation had submitted entries for schemes already in the pipeline.
"You need to do planning in advance - you can't just come up with an idea because there's a national initiative, but if you get these opportunities, it's great," she said.
But PCT Network director David Stout said the reliance on pre-existing plans was "probably no bad thing".
"We're looking for pilots that might have some chance of working." The pilots would be "a good test" of whether managers were ready for the freedoms they had demanded from the DH, he said.
Nearly two thirds of the shortlisted schemes involve the integration of primary care and social care. Nearly half include a voluntary organisation or social enterprise and nearly two thirds have a link with a secondary care organisation.
More than half of the schemes are for a population greater than 100,000 and schemes cover areas including long term conditions, older people's care, urgent care, mental health and children's services.
THE INTEGRATED CARE ORGANISATION SHORTLIST
NHS East Midlands
Heanor Commissioning Group; Nene Commissioning Community Interest Company; Nottingham City PCT; Principia Partners in Health
NHS East of England
Assura Cambridge; Beechwood Surgery (Brentwood PBC cluster); East and North Hertfordshire PCT; NHS Norfolk/Norfolk county council
Innovation Health Integrated Care Organisation; NHS Barking and Dagenham; Tower Hamlets PCT
NHS North East
Churchview Medical Practice; Durham Dales Cluster Integrated Care Organisation; Newcastle Hospitals foundation trust; Northern Doctors Urgent Care Limited; Northumbria Healthcare foundation trust (two schemes); Stockton on Tees teaching PCT
NHS North West
NHS Blackburn with Darwen; NHS Cumbria; South Central Practice Based Commissioning Consortium; Tameside and Glossop PCT; Wallasey Health Alliance
NHS South Central
NHS Milton Keynes
NHS South East Coast
Canterbury and Coastal Commissioning Consortium; Worthing Practice Based Commissioning Consortium
NHS South West
Bournemouth and Poole teaching PCT; Cornwall and Isles of Scilly PCT; North Cornwall Practice Based Commissioning Group; Saltash Health Strategy Group; Torbay Care trust
NHS West Midlands
South Staffordshire PCT
NHS Yorkshire and the Humber
Bradford and Airedale teaching PCT; Bradford Teaching Hospitals foundation trust; North East Lincolnshire care trust plus; North Yorkshire and York PCT; Wakefield Integrated Substance Misuse Services
The HSJ Commissioning Challenge is on 24 March, firstname.lastname@example.org