Eighty senior medics slam ‘disruptive’ push for landmark ICP contract

Consultants at the Dudley Group Foundation Trust have written to Dudley Clinical Commissioning Group over its plans to award a £360m integrated care contract to a new NHS trust.

The contract would cover primary care, community health and some public health services, and would include around 40 per cent of Dudley Group FT’s services.

Although the trust’s board has been involved in discussions with the CCG and the shell organisation – Dudley Integrated Health and Care Trust – it did not sign up to a strategic outline case in November 2019, and is understood to still have concerns.

Today senior trust clinicians have written a letter to the CCG, both trusts, and NHS England, requesting the development be paused for 12 months and for a review of the risks and benefits of the model to be carried out.

In a statement to HSJ the trust said it shares consultants concerns. 

The consultants’ letter, seen by HSJ, said: “We have been mired in a debate about organisational form in Dudley for six years, and it is time to stop. We do not accept there is a need for a disruptive and costly reorganisation of healthcare services in Dudley.

“The development of a third provider organisation, with a full trust board in Dudley is unnecessary…The excessive costs incurred to date in this project are already extremely concerning, given that no clinical services have been delivered after all this time.”

Consultants also said it would be “irresponsible” for commissioners to continue with the project during covid-19, as the “disruption and distraction that the ICP will cause will directly risk patient safety”.

They added: “The clinical model was clearly not written jointly… Consultants do not feel they have been listened to, and when we have tried to give constructive criticism it has been met with hostility…”

The letter also argues the trust was not being treated as a “partner” in the ICP, but as a “subcontractor.” However, they said they “believe there is a way forwards” and support “an alternative model” of collaboration.

In a statement, Diane Wake, chief executive for The Dudley Group FT said: The Dudley Group is firmly committed to working in an integrated way with all health partners across the Black Country to provide the best care for patients, at the right time and in the right place.

“We have seen the letter from our consultant body and the Trust shares their significant concerns, especially those around the clinical benefits to the people of Dudley. Our consultants have been raising their concerns for a while with ourselves and with our partners. We are committed to working with partners to resolve these issues.”

”We are proud of the work our consultants, and indeed all our staff, in dealing with COVID-19 and the restoration and recovery of our services, which is our main priority at the moment.

Earlier this week, Dudley CCG told HSJ it is working with the trust to address its concerns and planned to submit a full business case for the ICP by October this year. It said: “the key to progression is the submission of a valid business case and regulatory approval”.

Delivering integrated care is a key element of the NHS long-term plan, with NHS England producing a template ICP contract as one of the options for local systems. Dudley has appeared to be the only health economy which is close to implementing this.

In statement to HSJ, Dudley Integrated Health and Care TRust said: ”This has been a clinically-led five-year process which has had clinical input throughout and has been subject to a formal procurement. It has been a partnership process with Dudley CCG, Dudley Group FT, Black Country Healthcare FT, GPs in Dudley and Dudley Council. Our rationale has always been, and still is, to improve the health of the residents of Dudley who have some of the worst life-expectancy statistics in the country. 

 The partners are aware of Dudley Group’s concerns, and those of their consultants, and have a meeting next week to try to resolve them.”

 This story was updated at 17:15 with a quote from DGFT and Dudley Integrated Health and Care Trust.