STRUCTURE: Two London trusts have asked management consultants to assess their future configuration options, including a potential merger that would create one of the biggest providers in England.

West Middlesex University Hospital Trust and Imperial College Healthcare Trust have tendered for contractors to produce a strategic outline case outlining “options for service models and service locations” across both trusts.

The brief, seen by HSJ, says: “The severe financial constraints being faced across the NHS make it essential to consider scope for infrastructure rationalisation to enable long term and short term financial balance.”

It says the outline case will: “Support Imperial to develop its integrated business plan in accordance with its forthcoming foundation trust application. It will also inform the decision of the West Middlesex University Hospital board and commissioners on the preferred future organisational form.”

Imperial has a turnover of £900m and West Middlesex £149m which, if combined, would be similar to that resulting from the proposed merger of Barts, Whipps Cross and Newham hospital trusts.

Previous documents from local commissioners and NHS London suggest West Middlesex is not considered viable as a foundation trust on its own.

Imperial operates from four different sites and missed savings targets by £40m in 2010-11.

The tender said the finished strategic outline case would “consider, explicitly, the financial and service impact options” for West Middlesex.

It adds that bidders should consider trauma care and associated referrals.

In particular, it asks them to identify activity that will “no longer be referred to Imperial but will be referred to West Middlesex and other trusts [and] the potential for Imperial to attract new tertiary referrals”.