STRUCTURE: The health economy in North Somerset is hoping to move away from payment by results to achieve “maximum integration”, HSJ has been told.

Management from Weston Area Health Trust, North Somerset Council and North Somerset Community Partnership, the new social enterprise community provider, are developing a plan to form an integrated care organisation.

Weston chief executive Peter Colclough, who was chief executive at one of the first integrated health and social care providers Torbay Care Trust, told HSJ PBR would not be the “most appropriate form of payment” to achieve “maximum integration”.

He added: “I’m not saying [PBR] is not fit for purpose, the question is how does it [allow you] to really integrate.”

Council chief executive Graham Turner said the partners were keen to see the Government act on the advice of the joint King’s Fund and Nuffield Trust report on integration, published last week, and look beyond payment by results to “incentivising the whole health system to keep people out of hospital”.

Papers presented to Weston’s board reveal seven workstreams are in train examining how community and social care services can be integrated around agreed GP populations as well as the potential for developing integrated care pathways.

Another workstream is considering which services Weston should continue to provide onsite; which might be better delivered in partnership with another acute organisation or independent provider; which could be provided on site but by another provider and which would better delivered elsewhere.

This is likely to include further development of networks with North Bristol Trust and Univeristy Hospitals Bristol Foundation Trust as well as Taunton and Somerset Foundation Trust.

Weston informed the Department of Health last year it would not make foundation trust status in its current form.

The trust has until the end of March to provide the DH with a more detailed plan for its future. Documents presented to the board say the plan is to have “significant changes to the existing system in place by April 2013”.

Mr Turner, who is leading the work examining future organisational form, accepted this meant the partners were on a “burning platform” but said the plans were not just “about Weston Hospital and its future.”

“It’s about a whole health and social care system for North Somerset… We haven’t ruled anything out. We are looking for options that perhaps haven’t even been invented yet. On the one hand it could be an NHS organisation that becomes a foundation trust or it could be a social enterprise.

“We are quite interested in looking at models where we have a private sector partner.

He said rather than only looking to bring in the private sector when the public sector has failed, “we are wondering whether we can open our doors earlier… but it’s early days.”