Significant changes to how primary care trusts commission services are being considered as part of Lord Darzi's next stage review.

Sources have revealed to HSJ that pilots for integrated care schemes are strongly tipped to feature in the report due out in two weeks.

These could include trials of primary care trusts commissioning outcomes rather than services.

Provider organisations would then be given funding to deliver the outcomes. They could provide the services themselves or secure them from other organisations.

This would change PCTs' commissioning role, with more emphasis on scrutinising effective procurement of services by third parties.

It is understood local healthcare providers would be invited to propose integrated care schemes, which would then be tested and evaluated.

Sources said the proposals would move the financial risk away from PCTs and onto providers.

If GP practice-based commissioning consortia were included in the pilots, this would mark a step away from traditional concerns over conflicts of interest within practice-based commissioning groups.

Professor of health policy and management at Birmingham University Chris Ham said the conflict of interest applied as much to PCTs as to the consortia.

He predicted that PCTs would oversee the work of organisations providing the services to ensure they were working within the rules, rather than "trying to micromanage how systems work" if integrated care systems were introduced.

NHS Alliance chair Dr Michael Dixon said the alliance would support proposals to integrate care. "This is the second stage of a process started in 1948 of getting general practice into the health service, integrated with community services and secondary care," he said. "The big issues would be: are the frontline professionals up for it and prepared to take the risk and are the managers prepared to hand over the reins?"

Royal College of GPs chair Professor Steve Field warned the pilots should build on practice-based commissioning. They "should be based on areas of high-quality general practice already engaged in commissioning and working in an integrated way with colleagues in social care and specialist care".

In May, the Nuffield Trust warned the Department of Health should not dictate how to develop integrated care systems following the Darzi review.

Topics