'Unacceptable risk' to acutes exposed by PCTs' contract

The final model contract released last week has provoked fierce resistance from hospital providers, which have little time for the argument that it rebalances the power levels between primary care trusts and acutes (see news story - New model contract threatens survival, foundations warn.

In their unpublished submission to the Department of Health - seen by HSJ- foundation trusts claim it exposes them to 'unacceptable risk'. There is also concern about the way that PCTs are handling reductions in consultant-to-consultant referrals.

Many will believe that the model contract is an inept attempt to quickly reduce their power and destabilise their position, and will be used clumsily by commissioners for whom a number of acute providers have little respect.

That vexation increases with the prospect of fines for not meeting the milestone on the 18-week target - combined it means that acutes have to, as we report, 'steer a very tight course'.

Variation either way will bring fines and providers will be closely scrutinising the quality of PCT forecasting and monitoring - wily acute chief executives will see the contract as a very public test of PCT capability. Current disputes about upcoding may begin to look like small beer in comparison.

For its part the DoH seems to be playing down acute anger, with director of commissioning Duncan Selbie denying that it shifts risk almost entirely from commissioner to provider.

The DoH may feel that the contracts will not be enforced so stringently that acute trusts' worst fears are confirmed. If so it must be confident that foundations will not try to launch a full-scale flight to mediation and arbitration between now and the end of February.

The key thing is that legal contracts do not by themselves make or break new relationships. It is important that trusts do not automatically follow the new contract to the letter, as a substitute for real engagement and honest argument.

In this way they will avoid creating not a level playing field but one pitted with ever-deeper trenches over the next few weeks.