The clinical commissioning group running a £800m tender for older people’s services has revealed it could also tender a musculoskeletal service contract worth more than £50m a year.

A paper discussed at Cambridgeshire and Peterborough CCG’s October board meeting said the “large and complex [musculoskeletal] programme involving significant budget” had a value “potentially in excess of £50m per annum”.

“This provides the opportunity for a CCG wide approach for the commissioning of an integrated musculoskeletal service for planned care across the entire pathway,” the report by chief officer Nigel Smith said. This offered the chance to “address planned care in an outcome focused way and address the areas of difficult to control spend”.

However, the paper warned: “There is unlikely to be capacity within the CCG/local commissioning group to engage with this as well provide the clinical input into [the older people’s programme] if they run simultaneously.

“There is therefore a risk that musculoskeletal procurement could compete for the same resource as the older people’s and community service.”

It said the transfer of employees under transfer of undertakings (protection of employment) regulations would be “further complicated as staff may be eligible for transfer into both services”.

The musculoskeletal contract would cover planned care for adults and include self-referral services, physiotherapy, extended scope physiotherapy, rheumatology, podiatry, orthopaedics, pain management, neurology and elective procedures and surgeries.

The proposal follows nearby Bedfordshire CCG naming private company Circle Health as its preferred bidder to be “prime contractor” for an integrated musculoskeletal service in August.

The £120m five-year deal means Circle is financially and clinically accountable to commissioners for the whole pathway, which was previously divided up into 20 contracts across primary, secondary and community services.

Bedfordshire is the most advanced CCG in introducing this type of system but HSJ has identified a raft of similar deals in the pipeline.

These include a group of CCGs in Staffordshire planning to commission cancer and end of life care based on outcomes, and Oxfordshire’s proposal to bring in lead providers to integrate maternity, mental health and older people’s services.

Cambridgeshire and Peterborough has seen its financial position worsen since the start of the financial year. It has a year to date programme deficit of £831,000 when it had planned for a surplus of £417,000.

Finance director Tim Woods said the CCG was “still forecasting a year end surplus of £1m”.