MSK contract loss could 'negatively impact' trust

Coastal West Sussex Clinical Commissioning Group and the trust agreed to jointly commission an independent assessment into the potential impact of moving MSK services out of the trust, after the CCG awarded its contract for them to a joint venture between Bupa and CSH in September.

In response the trust warned this could destabilise its trauma services.

The new assessment by auditor PwC, published today, found that while moving some trust services into the community “can achieve benefits” it also has the potential to “negatively impact other services remaining in the trust”.

The auditors also concluded that the “cumulative impact of loss of MSK services” would result in the trust falling into deficit over the next five years.

The assessment found there were no agreed terms or draft contract in place between the CCG and Bupa/CSH. It said given the new service was due to commence in April “there is a considerable amount of work to be completed by all parties if the new contract is to be signed and commence on time”.

The assessment noted that clinical governance procedures for the contract were “currently unclear and therefore pose a potential risk”. This risk will be felt “specifically if providers conduct outpatient activity but do not also provide inpatient services”.

Under the contractors’ current plans no community physiotherapy, rheumatology or pain management activity would be subcontracted back to the trust.

The loss of MSK services could also make staff recruitment, retention and training “more challenging” for the trust, the auditors noted.

It is estimated the trust could remove 75 per cent of its direct costs related to the services, such as staffing and theatre costs, in the first year of the contract, which the auditors found may result in a £2.7m negative “contribution impact”. However, they said that if the 75 per cent cost removal was lowered to 50 or 25 per cent the negative impact would be £5.4m or £7.6m.

The cumulative impact across the five year contract could be £13.4m, the auditors estimate.

The CCG, on publishing the report, said it would now work with the trust and Bupa CSH to examine the “financial and clinical implications” of awarding the contract. The CCG said it still intended for the contract to begin in April, although it would not be signed until it was reassured further.

Coastal West Sussex CCG chief clinical officer Katie Armstrong said: “The impact assessment has given us the opportunity to fully explore the financial and clinical implications of the contract award. We are looking forward to working with [the trust and Bupa CSH] to understand the mitigating actions, and we remain committed to improving MSK services for patients.”

Western Sussex Hospitals Foundation Trust chief executive Marianne Griffiths said the joint assessment had shown that an MSK service run by Bupa CSH “would have serious clinical and financial implications that, if not mitigated, would seriously affect the care we are able to provide for patients in our hospitals”.

She added: “We are now looking at the cost, viability and practicality of the mitigations needed to guarantee that no patients are adversely affected by the new contract proposals.”