Portsmouth system plans integrated provider

NHS leaders in Portsmouth hope the move, encompassing primary, community and secondary services, will reduce demand for hospital care and save £155m over three years, or 15 per cent of local NHS resources.

The latest version of a “sustainability plan” produced jointly by NHS providers and commissioners says: “It is the aspiration of commissioners to contract through a single entity for the provision of integrated care for the frail elderly and those with long term conditions.”

The plans say although services are working well in isolation, “they don’t operate sufficiently well as an effective system – and don’t consistently have the full support, ownership and confidence of clinicians and patients”.

Specifications for a more integrated service design and organisation are due to be produced later this month. The organisations involved include Portsmouth Hospitals Trust, Solent Health Trust, three clinical commissioning groups, and GP practices

It is hoped the integrated body can be created in 2013-14 or 2014-15. How it will be constituted and funded are yet to be agreed.

However, HSJ understands that the favoured local option is to set up an NHS “shared services” organisation, in which all local partners had a stake. Other options being considered include a joint contract covering some of the revenue paid to local providers, or a standalone private company.

One source developing the plans told HSJ that trying to use the payment by results tariff to fund the provider would be a “clumsy construct” and they would prefer to use the “year of care” per patient funding model.

Those developing the plans say if they are successful they will leave some beds at the Queen Alexandra Hospital left vacant, which would reduce costs.

However, it would not address the hospital’s liability under a private finance initiative deal, and the sustainability plan says services and staff from elsewhere in the system will be moved to Queen Alexandra and “alternative uses” of vacant capacity, including commercial uses, will be explored.

The plan also indicates the hospital trust could be compensated for “residual stranded PFI costs” – those where the trust is left with PFI buildings and facilities it no longer needs.