STRUCTURE: GPs in Staffordshire have proposed a “radical” approach to service provision at Mid Staffordshire Foundation Trust.

The news came as it emerged the organisation has received a £21m bailout to tide it over until the end of the financial year.

The chairs of Stafford and Surrounds and Cannock Chase clinical commissioning groups, Steven Powell and Johnny McMahon respectively, recommend the trust provides just four specialties across its two sites: diagnostics, outpatients, a midwife led maternity unit and an urgent care centre.

They fear Mid Staffordshire’s projection of an £11.4m deficit by 2014-15 is optimistic and say £15m savings are required to avoid the “slow death” of Stafford Hospital.

“The health economy has been charged with ‘thinking the unthinkable’ and we feel that as future commissioners we have a duty to take this requirement seriously,” they say in a letter to Graham Irwin, chief executive of the Staffordshire primary care trust cluster.

The trust’s own plan for its future viability, which included a 40 per cent reduction in beds, was rejected by the Department of Health last autumn as it showed an £11.4m annual deficit by 2014-15. A revised plan was due to go to Monitor and the DH by the end of January but HSJ understands it has not yet been agreed.

Papers due to go to the trust’s board today show it is forecasting a year-end deficit of £20.7m against a planned £18m. The papers reveal the trust has “secured” £16m in cash support for 2011-12.

HSJ understands a total support package of £21m was agreed with the DH at the end of January, with £5m of this being paid back to the DH as public dividend capital payments. This total is significantly less than the £40m the trust wanted to see it through to the end of 2012-13. However, the DH has promised further “cash support” over the next three years.

In their letter the CCG chairs complain commissioners have effectively bailed out the trust for the past two years with above-tariff payments. They also criticise a “lack of leadership” from the trust.

The letter suggests outpatient services could be run on a “satellite” basis by neighbouring acute trusts, with urgent care delivered by primary care providers. Other services currently provided by the trust could be delivered either in the community or at neighbouring acute providers.

A spokeswoman for the Staffordshire PCT cluster said it understood the GPs were frustrated by an “apparent lack of progress” but any changes would be subject to full public consultation.