An NHS hospital has pledged to compete with Circle Partnership, the private provider appointed to run Bedfordshire’s £120m integrated musculoskeletal service, after refusing to become its subcontractor, HSJ can reveal.

Bedford Hospital Trust has refused to sign the contract after seeing the number of MSK referrals plunge 30 per cent after Circle took over the service in April.


The trust chief executive said there was now a risk its income from MSK would no longer support its consultant surgeons

The trust claims the service’s arrangement “endangers the viability” of its trauma and accident and emergency services and could undermine its capacity to retain the seven trauma surgeons it employs.

Circle was awarded the five year “prime provider” contract by Bedfordshire Clinical Commissioning Group in April. The deal consolidates 20 separate contracts into a single service and gave Circle the role of running it.

Bedford Hospital’s board papers say it “would not be in the trust’s best interests to sign a contract without any mitigation to the consequent impact on trauma and linked services”.

“The significant reduction in referrals since April, and associated potential loss of income (assuming these convert to elective work) mean a direct impact on the viability of the trauma service which in turn will undermine the ability of A&E to see and admit trauma patients,” they say.

Trust chief executive Stephen Conroy told HSJ there was now a risk its income from MSK would no longer support its contingent of consultant surgeons.

“At some point at the future that would mean the service would either lose a lot of money or become non-viable,” he said. “We’ve got enough need to keep us going until the end of next financial year [but] it remains an open risk for next year.”

Bedford has requested a minimum income guarantee for 2014-15 to cross subsidise the trauma service. This was declined by the CCG and Circle on the grounds it would limit patient choice.

Mr Conroy said the trust was still negotiating with the CCG about the possibility of a risk share arrangement in 2015-16.  

Bedford’s contract with the CCG to provide MSK services came to an end in September.

A spokesman for Circle said: “Most providers recognise our job is to integrate MSK services, so they are more joined up for patients and more efficient for the local NHS.”

“We’ve had constructive discussions with Bedford and expect to sign a contract in the coming months.”

“The new system is led by informed patient choice. The best way for any provider to increase referrals is to give patients what they want.”

Bedfordshire CCG declined to comment.