Survey: What commissioners want to happen to their unsustainable providers

Acute trust mergers and Hinchingbrooke style management franchises were the least popular options for restructuring troubled providers.

The latest HSJ clinical commissioning group barometer, carried out with Capsticks, found that three-quarters of CCG leaders believe there is at least one unsustainable acute provider on their patch or in their wider local health economy.

Asked which changes to organisational form they would support for these troubled trusts, the options most popular among respondents were for the trust:

• to remain independent but form joint ventures with others;
• to join with local GPs to form a multispecialty community provider; or
• to become part of an organisational chain with other secondary care providers.

The least popular options were for the provider:

• to become a social enterprise;
• franchise its management to another organisation; or
• pursue a traditional merger with another trust or foundation trust.

Forty-eight CCG chairs and accountable officers responded to the survey in July.

It comes as ministers and national officials are thought to be considering options for unsustainable providers. A government commissioned review by Sir David Dalton, published in December, proposed options including hospital chains, management franchises, service level chains, joint ventures and integrated care organisations.

The barometer found 74 per cent of CCG leaders would be in favour of their unsustainable providers establishing shared service joint ventures, the most widely supported of the options given.

Sixty-eight per cent of respondents said they would support the trust joining with GPs to form a multispecialty community provider, while 64 per cent said they would back it becoming part of an organisational chain.

The least popular option was “full management franchise” of the trust to another organisation, with 67 per cent against it. This follows the collapse in January of the franchise of Hinchingbrooke Health Care Trust to private provider Circle, the only deal of its kind in the NHS.

The next most unpopular options were becoming a social enterprise, with 49 per cent opposed, and merger with another trust, with 46 per cent opposed.

Oxfordshire CCG chief officer David Smith said: “Full mergers take a lot of management time and resource. I think it is questionable whether those mergers… are able to deliver the proposed benefits and whether those improvements in service or savings are made fast enough.”

NHS Providers head of policy Miriam Deakin added: “Mergers and acquisitions are perhaps seen to be quite time intensive [and] very costly.

“I think people sometimes see the competition rules as a barrier to mergers also and feel that collaboration is more culturally appropriate for the NHS.”