• Commissioners consulting on major overhaul of elective orthopaedic surgery in north central London
  • All elective, inpatient orthopaedic work will be done by two cold sites
  • Plans partly aimed at capturing activity currently commissioned from private sector

A health system is proposing to consolidate seven NHS units that deliver inpatient elective orthopaedic surgery into two — aimed partly at capturing activity from the private sector.

The plans would create two partnerships in north central London, each made up of an “elective centre” doing the inpatient work as a cold site, and a base hospital, that would continue to do emergency activity and some day-cases, as well as pre- and post-operative care.

A new unit at University College London Hospital would be the elective centre for one partnership, carrying out up to 400 more inpatient procedures per year, with The Whittington Health Trust as its base hospital.

Chase Farm Hospital would be the other centre, with up to 960 more patients per year. North Middlesex University Hospital Trust will be its base hospital.

Each pair of trusts submitted a joint proposal to form one of the two partnerships, which were the only proposals received by commissioners by the July 2019 deadline. A public consultation on the proposed new care model will run until April.

Current elective orthopaedic surgery sites

  • North Middlesex University Hospital Trust;
  • Royal Free Hospital (Royal Free London FT);
  • Chase Farm Hospital (Royal Free London FT);
  • Royal National Orthopaedic Hospital Trust;
  • University College London Hospital (University College London Hospital FT);
  • National Hospital for Neurology and Neurosurgery (University College London Hospital FT); and
  • Whittington Health Trust.

Separating inpatient elective surgery on to “cold” sites should mean procedures are no longer cancelled by prioritised emergencies, decreasing waiting times. It could also improve outcomes because the cold sites will have theatres only doing orthopaedic work.

The health system also anticipates the plan would free up capacity to allow NHS providers to repatriate activity commissioned by private hospitals, run by BMI Healthcare and Aspen.

Both partnerships “will benefit over the medium term from a shift of activity from the private sector”, the consultation document said. If the new model of care is adopted it is anticipated “commissioners would look to cease directly commissioning work from the private sector”.

There were approximately 10,000 elective inpatient cases across the patch in 2017, 9,600 of them by NHS providers and a further 360 by private providers. NCL’s commissioners predict this will rise by 1.8 per cent to 10,200 by 2023.

The Royal Free partnership is estimated to deliver a saving of £1.37m by 2023-24 by removing a loss-making service from NMUH and filling spare capacity at Chase Farm.

The UCHL partnership will be centred around a new building at UCLH called “phase 4” which is currently under construction with work due to be completed this year. The Whittington’s elective orthopaedic service makes a positive contribution to system finances.

However, the two trusts’ services, taken together, make a net loss. Analysis shows they will continue to do so under the new plan because “as a new building phase 4 attracts a high charge for overheads so the cost of orthopaedics at UCLH increases as a result of the move”.

It estimates there will be a two-year “transition period” wherein the partnership will make a loss based on transition costs and stranded costs at The Whittington, incurred because it will be paying for spare capacity from the move of inpatients over to UCLH, as well as the loss of income from those inpatients.

However, a total net gain from the new service of £59,000 is expected by 2023-24, compared with the status quo, thanks to repatriating private activity, “efficiency gains” and recovering the stranded costs.