Primary care trusts are edging closer to determining the future of their provider arms.

HSJ has obtained the detail of PCT plans for their provider arms in all but two strategic health authority regions.

Social enterprises appear to have failed to capture the imagination of PCTs

The plans show the future of provider arms will be spread almost equally between vertical integration with acute providers, mental health providers and new standalone community foundation trusts.

The Department of Health’s deadline for PCTs to have a “firm plan” for externalising provider arms passed last Thursday. However a number of plans have yet to reach their PCT’s board for decision. In 21 out of 120 PCTs proposals have either been rejected or are uncertain.

Of the 99 PCTs with firm plans, 29 expect their community services to be absorbed by an acute hospital provider. In 16 cases, the most likely acute provider is a not a foundation trust which means the final go-ahead on the plans will be dependent on the approval of the foundation trust regulator Monitor.

Thirty-one PCTs plan to turn their provider arms into community foundation trusts, in many cases through a merger with one or more other provider arms.

The largest, if approved, would incorporate five former PCT provider arms in London.

Twenty-eight out of the 120 PCTs plan to move their provider arm to a local mental health provider - in most cases a foundation trust.

If those proposals go ahead North East London Foundation Trust could find itself hosting the provision for five different PCT areas. Pennine Care Foundation Trust could run services in three areas.

Social enterprises appear to have failed to capture the imagination of PCTs, with only 10 submitting new bids to establish the organisations.

Regionally the picture is far from uniform. Proposals in Yorkshire and the Humber and East Midlands would see provider arms split into the most and smallest sections - with many provider arms being divided between a number of alternative organisations.

The North West, by contrast, has seen the highest proportion of bids from acute foundation trusts - forming half the national total.

NHS East of England has the greatest variety of organisational forms and plans a higher number of social enterprises and aspirant community foundation trusts than other areas.

The SHA’s transition director of provider development Stephen Dunn said that showed the influence of its work finding a new operator for Hinchingbrooke Health Care Trust. He said: “We are not giving away valuable assets cheaply.”

NHS North East was due to publish its list of Transforming Community Services proposals after HSJ went to press.

NHS South West would not release any details of the TCS proposals it had seen, evaluated or approved.

Provider arms must be separated from PCTs by the end of March 2011.


Proposed integration plans

Vertical integration with an acute foundation trust

NHS Lambeth and NHS Southwark Both propose to integrate with Guy’s and St Thomas’ Foundation Trust.

NHS Bolton Royal Bolton Hospital Foundation Trust.

NHS Blackpool and NHS North Lancashire Both approved locally to integrate with Blackpool, Fylde and Wyre Hospitals Foundation Trust.

NHS Salford Integrating with Salford Royal Foundation Trust.

NHS Sutton and Merton Integration with Royal Marsden Hospital Foundation Trust - approved by board locally.

NHS City and Hackney Integrating with Homerton University Hospital Foundation Trust. DH APPROVED

NHS Stockport and NHS Tameside and Glossop Local boards have approved integration with Stockport Foundation Trust.

NHS Milton Keynes Milton Keynes Hospital Foundation Trust.

NHS Warwickshire Integrating with South Warwickshire Foundation Trust. DH APPROVED

NHS Rotherham Three-quarters of services to integrate with the Rotherham Foundation Trust, the rest integrating with Rotherham, Doncaster and South Humber Mental Health Foundation Trust.

NHS Newcastle to Newcastle upon Tyne Hospitals Foundation Trust.

NHS North Tyneside and Northumberland Care Trust to Northumbria Healthcare Foundation Trust.

NHS Gateshead, NHS South Tyneside and NHS Sunderland to South Tyneside Foundation Trust.

NHS County Durham and NHS Darlington to County Durham and Darlington NHS Foundation Trust.

NHS Middlesbrough and NHS Redcar and Cleveland to South Tees Hospitals NHS Foundation Trust.




Vertical integration with a non-foundation acute trust

NHS Brent, NHS Ealing and NHS Harrow Ealing Hospital Trust.

NHS Croydon Integration with Mayday Hospital Trust, active as of 1 August. DH APPROVED

NHS Haringey and NHS Islington Whittington Trust to create an integrated care organisation.

NHS Lewisham Lewisham Hospital Trust. DH APPROVED

NHS Wandsworth St George’s Healthcare Trust.DH APPROVED

NHS Trafford Trafford Healthcare Trust.

NHS Buckinghamshire Merger with Buckinghamshire Hospitals Trust.DH APPROVED

NHS Hereford Hereford Hospitals Trust with council social care services. DH APPROVED

NHS Wolverhampton Bulk of services to Royal Wolverhampton Hospitals Trust. DH APPROVED

NHS Walsall Walsall Hospitals Trust. DH APPROVED

NHS Sandwell Sandwell and West Birmingham Hospitals Trust.

NHS Wakefield District Most services to Mid Yorkshire Hospitals Trust.

NHS North Somerset Preferred option put to the board was for community services to form an Integrated Care Organisation by integrating with services currently provided by Weston Area Health Trust. The final decision on a full ICO is dependent on some further work being done on the full range of services that will be provided.The board therefore also approved a parallel process of undertaking a Right to Request to form a community social enterprise.

Integration with mental health provider

NHS Dorset Board agreed that given the “challenging timetable” of TCS interim integration with Dorset HealthCare University Foundation Trust was the best option. Undertook that the interim arrangement would noty last more than two years.

NHS Bournemouth and Poole PCT board agreed Dorset Healthcare University Foundation Trust as preferred host for provider arm. An earlier meeting had seen the mental health trust raise concerns “over support service costs and management cost reductions.”

NHS Cumbria Cumbria Partnership Foundation Trust.

NHS Leicestershire County and Rutland and NHS Leicester City Majority of services going to Leicestershire Partnership Trust.

NHS Northamptonshire Majority of services going to Northamptonshire Healthcare Foundation Trust.

NHS South West Essex, NHS Redbridge and NHS Waltham Forest Proposed integration with North East London Foundation Trust. DH APPROVED

NHS West Essex Deciding between North East London Foundation Trust or South Essex Partnership University Foundation Trust.

NHS Barking and Dagenham Already integrated with North East London Foundation Trust. DH APPROVED

NHS Bexley Oxleas Foundation Trust and the acute provider South London Healthcare Trust. DH APPROVED

NHS Camden and NHS Hillingdon Central and North West London Foundation Trust.

NHS Enfield Barnet, Enfield and Haringey Mental Health Trust. DH APPROVED

NHS Greenwich Oxleas Foundation Trust.

NHS Newham East London Foundation Trust.

NHS Bury, NHS Oldham and NHS Rochdale, Heywood and Middleton Applying to SHA to merge with Pennine Care Foundation Trust.

NHS Blackburn with Darwen Teaching and NHS Central Lancashire Both are proposed to transfer most of their services to Lancashire Care Foundation Trust, with the remaining services to be integrated with an acute provider.

NHS Knowsley Proposed transfer to the 5 Boroughs Partnership Foundation Trust for a two to three year interim period.

NHS West Cheshire Cheshire and Wirral Partnership Foundation Trust.

NHS Oxfordshire Oxfordshire and Buckinghamshire Mental Health Foundation Trust. DH APPROVED

NHS Berkshire East and NHS Berkshire West Berkshire Healthcare Foundation Trust.

NHS Hampshire Hampshire Partnership Foundation Trust.

NHS Coventry Transfer of adult and children’s services to Coventry and Warwickshire Partnership Trust. DH APPROVED

NHS East Riding of Yorkshire Plans to integrate with Humber Foundation Trust being assessed by the co-operation and competition panel. DH APPROVED

Social enterprise

NHS North Lincolnshire Three separate social enterprises. DH APPROVED

NHS Nottingham City Social enterprise for just over half of services, the rest tendered.

NHS Great Yarmouth and Waveney; NHS Mid EssexDH APPROVED; NHS North East EssexDH APPROVED; NHS MedwayDH APPROVED; NHS Surrey; NHS Kirklees; NHS Bristol Single social enterprises.

NHS Kingston Provider arm already a social enterprise. DH APPROVED

NHS Hull Provider arm already a social enterprise. DH APPROVED

NHS Bristol Proposes a social enterprise arrangement bid or interim arrangement prior to one.

NHS Cornwall and Isles of Scilly The board approved plans for a countywide social enterprise for adult community health services and that a two-year hosting arrangement is put in place for children’s community health services. The host organisation has not been identified yet.

NHS Plymouth PCT board approved a move towards social enterprise.

NHS Swindon The trust confirmed it was pursuing social enterprise for everything expect children’s services which were already integrated with the local authority. A spokeswoman said this would not be confirmed with the board until December.

NHS Gloucestershire Announced it would be pursuing the social enterprise option for most services, with “some services transferring to other NHS bodies”.


Aspirant community foundation trusts

NHS Derbyshire County; NHS Hertfordshire; NHS NorfolkDH APPROVED; NHS LiverpoolDH APPROVED;NHS Wirral; NHS LeedsEach planning to be single CFTs.

NHS Lincolnshire Offender health and specialist learning difficulties to be separated.

NHS Cambridgeshire Already a CFT DH APPROVED

NHS Barnet; NHS Kensington and ChelseaDH APPROVED; NHS Hammersmith and Fulham and NHS WestminsterDH APPROVED Proposed merger to create Central London Community Healthcare CFT.

NHS Hounslow and NHS Richmond Merger to create CFT.

NHS Ashton, Leigh and Wigan Expects to become a trust on 1 November. DH APPROVED

NHS Halton and St Helens Proposed temporary transfer to Ashton, Leigh and Wigan Community Foundation Trust.

NHS East Sussex Downs and Weald and NHS West SussexDH APPROVED Merger with South Downs community health trust to be approved by CCP.

NHS Eastern and Coastal Kent Expecting to become a CFT on 1 November.

NHS Hastings and Rother Merger with South Downs Health Trust.

NHS West Kent Merger with NHS Eastern and Coastal Kent CFT.

NHS Birmingham East and North; NHS Heart of Birmingham and NHS South Birmingham Merger to create Birmingham Community Health Care Trust. DH APPROVED

NHS Shropshire and NHS Telford and Wrekin Joint bid is due to face a DH challenge panel and transaction board process.

NHS Stoke, NHS North Staffordshire and NHS South Staffordshire Joint CFT bid.

NHS Warrington Majority of provider arm going to Ashton, Wigan and Leigh Community Healthcare Trust. Six other services to Warrington and Halton Hospitals Foundation Trust, one service transferring to the council. DH APPROVED


NHS South Gloucestershire The PCT board approved proposals to:

Transfer of NHS South Gloucestershire Provider Adult services to North Bristol Trust for a maximum period of two years from 1 April 2011.

Transfer NHS-employed Adult Learning Difficulties staff from NHS South Gloucestershire to North Bristol Trust for a maximum period of two years from 1 April 2011.

Transfer Church House Children and Young People’s Respite Service to North Bristol Trust for a maximum period of two years from 1 April 2011.

Transfer Children’s Health Visiting Services to the Children and Young People’s Partnership within North Bristol Trust on a permanent basis from 1 April 2011.


NHS Wiltshire As of October 5 the PCT had not had proposals submitted and didn’t expect to make any announcement until November. A spokeswoman said: “We are waiting for proposals to be submitted and obviously these will be subject to a great deal of planning and detail, as well as the statutory assurance processes.” 

NHS Somerset The PCT said it was doing due diligence work on two separate options but would not be making a decision before the end of the month. One was to work up a social enterprise bid, the other to integrate with mental health organisation Somerset Partnership NHS Foundation Trust.

NHS Devon The board said it needed more time to agree on permanent hosts for its provider arm and agreed to pursue an interim option for no more than two years. It said community services in eastern Devon and some specialist services, such as health promotion, would be managed by Northern Devon Healthcare NHS Trust. Services in the south of the county will be managed by Torbay Care Trust.

NHS Stockton-on-Tees and NHS Hartlepool Services were externalised to North Tees and Hartlepool NHS Foundation Trust in November 2008. The services are still with the Foundation Trust but the PCTs plan to tender them.

NHS Bassetlaw Services to be transferred to either Rotherham Foundation Trust, Nottinghamshire Healthcare Foundation Trust, Doncaster and Bassetlaw Foundation  Trust, or combination of these trusts. Board decision at the end of October 

NHS Derby City Services totalling just under half of the community services budget are being tendered out. A third of services are being transferred to the local authority and the remnants are proposed to form a social enterprise, or move to acute and mental health providers.

NHS Nottinghamshire County Tendering out services for entire £99m budget.

NHS Tower Hamlets Proposals include merger with Barts and the London Trust or with East London Foundation Trust or with Central London Community Health. Three separate social enterprise bids also being considered.

NHS East Lancashire The strategic health authority has taken over the process after “concerns about the viability of proposals”.

NHS Isle of Wight Integrated provider trust with integrated hospital and community care planned.

NHS Sheffield Plans for a mix of vertical integration with acute provider, mental health and local authorities.

NHS Portsmouth City and NHS Southampton City Plans to make the PCTs’ merged provider arms - Solent Healthcare, set up in April - a CFT were not signed off by the SHA, who said more work was needed to make the case.

NHS Peterborough Considering merger with either Cambridgeshire Community Services or Cambridgeshire and Peterborough Foundation Trust.

NHS Luton Considering merger with either Cambridgeshire Community Services or South Essex Partnership University Foundation Trust.

NHS South East Essex Considering vertical integration with either Surrey-based Epsom and St Helier University Hospitals Trust, Southend University Hospital Foundation Trust, South Essex Partnership University Foundation Trust or North East London Foundation Trust.

NHS Suffolk Undecided between merger with West Suffolk Hospital Trust, The Ipswich Hospital Trust or Suffolk County Council.

NHS Sefton Proposal to transfer 60 per cent of services to Liverpool Community Foundation Trust and 40 per cent to Southport and Ormskirk Hospital Trust.

NHS Barnsley Decision due in Mid October over whether to integrate with Barnsley Hospital Foundation Trust or South West Yorkshire Partnership Foundation Trust.

NHS Calderdale Proposal to split services between South West Yorkshire Partnership Foundation Trust and Calderdale and Huddersfield Foundation Trust. DH APPROVED

NHS Doncaster Tender underway. Bidders consist of Rotherham, Doncaster and South Humber Mental Health Foundation Trust, Doncaster and Bassetlaw Hospitals Foundation Trust and Rotherham Foundation Trust.

NHS Dudley Proposed split between South Birmingham Community Foundation Trust, Sandwell Mental Health and Social Care Foundation Trust, The Dudley Group of Hospitals Foundation Trust and a social enterprise.

NHS Bradford and Airedale Proposed split between Bradford District Care Trust, GPs and some into Bradford Teaching Hospitals Foundation Trust. DH APPROVED

NHS Solihull Care Trust Takes proposals to board this month.

NHS Worcestershire Board has proposed that Worcestershire Mental Health Partnership Mental Health Trust be dissolved and an integrated community/mental health organisation formed.

NHS Bath and North East Somerset A spokesman wouldn’t confirm any more than: “Transforming Community Services proposals are being developed with four options for separation being considered. A preferred choice will be subject to local decision-making during November.”