• Single service models being developed for 10 acute pathways to “deliver efficiencies”
  • Plans show that “political opposition”, “capital constraints” and “insufficient workforce” are all risks to implementation
  • CCG plans MCP development and staff reorganisation that could result in redundancies
  • STP wants to see “repatriation” of out of area NHS work to help reduce provider deficits

Acute services at Kettering General Hospital Foundation Trust and Northampton General Hospital Trust are to be merged as part of sustainability and transformation plans, HSJ can reveal.

The plans state that while the Northamptonshire STP has “not opted for organisational merger” of the trusts “given the direction of travel this may occur in the future”.

HSJ made a successful freedom of information request to obtain Nene Clinical Commissioning Group’s back office and unsustainable services consolidation plans, which it submitted to NHS Improvement in July. Nene CCG is the commissioner for both hospitals, and the STP includes Kettering General, Northampton General, Northamptonshire Healthcare FT, Nene CCG, Corby CCG and Northampton county council.

The documents show that a single service model for 10 specialities is in the process of being created, with a memo saying “this is how the STP footprint will deliver efficiencies from its planned care specialities”. The reconfiguration will see the integration of clinical directorates at each site and non-acute care primarily offered “out of hospital [to] enable efficiencies to be unlocked”.

The 10 pathways under review are:

  • cardiology;
  • ophthalmology;
  • ear, nose and throat;
  • gynaecology;
  • urology;
  • radiology;
  • pathology;
  • rheumatology;
  • dermatology; and
  • orthopaedics.

The last three already have advanced plans and put much greater emphasis on delivering care in the community through “hubs”, GPs or community based clinicians offering more appointments.

Options were still being considered in July, but the documents said it was likely that elective and non-elective work would have to continue to be offered at both Kettering and Northampton hospitals, as the STP faced “capital constraints” preventing building expansion or reconfiguration. As an example, it said neither hospital has enough theatre or ward capacity to offer all orthopaedic work from one site.

The memo warned that elective work from other NHS and non-NHS providers faced “repatriation” as this would be a “key element in closing the finance gap for both acute providers”. Kettering ended the last financial year with a £10.3m deficit, while Northampton’s deficit was £12.6m.

However, the note warns that there may be “insufficient workforce” to implement the plans – singling out a potential lack of programme managers and clinical capacity to deliver the pathway reviews. It also said “transitional costs” for service change was a “key risk” alongside enough workforce being available to deliver new care models, especially in primary care. The STP anticipates “political opposition to large scale change”.

The plans also say it is “envisaged” that a single back office system will be in place by April 2017 to cover procurement, HR, information management, technology, and estates across all providers and CCGs in the patch. The hospitals will keep their own finance and performance management teams.

Nene CCG also plans to move towards the development of a multispecialty community provider, which it said could face “resistance from GP practices”. As part of this process the plans recognise there may be “potential redundancy costs” as it restructures staff locally “towards federation facing posts”. It also said CCG management budgets will no longer form part of the STP budget, suggesting staff in those roles will be offered alternative post or redundancy.

The STP is also keen to look at integrating pathology “across a larger footprint that that of the Northamptonshire STP”. It said it was also looking for investment from NHS Improvement in transport and infrastructure to “implement a shared pathology service for the county”. The plans say an integrated IT system for pathology is also “not currently affordable”.

STPs made new “full” submissions of their plans on Friday. Northamptonshire has not yet published its plan but a spokesperson for Northampton General Hospital Trust told HSJ: “The final arrangements for full publication [of its STP] are being agreed. All organisations are committed to working together and ensuring patients, service users, carers and our wider community continue to have opportunities to help us develop our plans. At this stage it is important to note that a single, countywide service does not mean a service provided from a single site. It means collaboration between the trusts with a focus on maintaining localism.”