Private companies must take on more risk if they want to gain a bigger share of the primary and community care market.

Harrow primary care trust chief executive and chair of the London PCTs’ commercial board Sarah Crowther said the perception within the health service had been for some time that risk sharing had been working in favour of the independent sector.

She said: “Perhaps what [independent sector providers] need to think about for the next period of time is how do you incentivise PCTs to change some of their provider relationships, to have the confidence to work with you.”

Ms Crowther, speaking at an NHS Confederation seminar, said the DH commercial directorate, which has been replaced by local commissioning support units, “hadn’t done the independent sector any favours” by negotiating costly deals which loaded risk back onto the NHS.

She said: “The days when it was all about how do you get the independent sector involved are gone. Actually what we’re interested in as commissioners is who is the right provider to give us the right deal to provide the right service.”

But she acknowledged not all PCTs would be taking the same approach to competition and co-operation.

“That may not be perfect, but it’s the reality. Get over it,” she said.

She advised independent providers to think about taking on projects that were not of optimum size in the first instance, in order to build a track record.

Linked to that, PCTs needed to get better at building relationships, she added.

And the private sector would need to tell commissioners how it was going to help them take capacity out of the health system.

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