STRUCTURE: A key architect of the foundation trust legal structure has said the sector’s existing governance models can be used to run the new models of care set out in the NHS Five Year Forward View.

Governance models for the new care models have not yet been established but Steve Dunn, who played a lead role in establishing foundation trusts while senior strategy adviser at the Department of Health, said the FT structure can be used to establish primary and acute care systems (PACS).  

Stephen Dunn

Stephen Dunn is disappointed West Suffolk FT was not selected as a vanguard area but says the trust will continue with its integration plans

Now chief executive of West Suffolk Foundation Trust, he told HSJ he wanted to create what he called a “primary and acute system foundation trust” although, crucially, GPs would not be directly employed by the organisation, at least in its first iteration.

West Suffolk was involved in a bid, led by West Suffolk Clinical Commissioning Group, to establish a PACS under NHS England’s new models of care programme, but it failed to make the list of 29 vanguard areas announced earlier this month.

The proposals said West Suffolk wanted to “establish a clinically led network of GP, community and acute service providers under one organisation - West Suffolk Health and Care”.

The strategy proposed the new organisation took control of “the district general hospital, community [and] out of hours/111 contracts” by 2016-17. At that point, it would consider “the option of direct employment of GP providers”.

Dr Dunn told HSJ that while the West Suffolk CCG’s clinical executive group was supportive of the bid, like many other areas across the country, some local GPs had raised concerns about being direct employees of a new organisation.

Dr Dunn said he was “hugely disappointed” not to be selected as a vanguard area but insisted the trust would forge ahead with its integration plans.    

He said: “We can adapt the FT governance and legal structure. We believe we can do that quite quickly with a bit of help and support from the regulators.

“Why I think what we’re doing is exciting, is rather than set up a new joint venture and a new complex legal structure, we will change and evolve the existing FT legal structure.”

Foundation trusts can oversee contacts under an alternative provider medical services model. GPs in West Suffolk are commissioned under either general medical services or personal medical services contracts, which FTs cannot hold.

Under the arrangements, the CCGs would still have a role overseeing quality assurance and scrutiny but it would be scaled back considerably.

West Suffolk CCG chief officer Julian Herbert told HSJ the group would play a role comparable with that “played by police and crime commissioners”, with much of “the demand management and service design functions” transferred to the integrated care organisation.