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PCTs clamour to put entire care pathways out for tender

Exclusive Private companies are poised to bid to run huge chunks of NHS care across the country, as a host of PCTs follow NHS East of England's controversial lead in placing entire care pathways out to tender.

NHS East of England plans to auction off £300m of services to GPs, private companies or a combination of the two, in pathways including respiratory and musculoskeletal medicine.

Eight PCTs are now planning to replicate the NHS East of England plans, which Pulse first revealed in March and are backed by an adviser to the Government's QIPP programme.

Pulse has established that NHS Bassetlaw, NHS Hampshire, NHS Coventry, NHS Brighton and Hove and NHS Outer North East London, a cluster covering four PCTs, are all considering putting entire care pathways out to tender, with several having started discussions with GP commissioners about the move. 

NHS Outer North East London said it would tender out entire care pathways and would ‘provide an outline programme of these once prioritised and agreed with GP consortia and existing service providers'. NHS Bassetlaw said it had already awarded tenders for musculoskeletal and dermatology pathways, worth £680,000 and £775,000 respectively, to NHS providers.

Other PCTs said parts of care pathways would be tendered out. NHS Calderdale said it would put intermediate care beds out to ‘full competitive tender' as part of a redesign of its 'intermediate tier'. An NHS Calderdale spokesperson said: 'This will involve a full competitive tender process which will be open to all. This second phase is currently being scoped, and it is not possible to confirm the value of the tender at this stage.'

In NHS East of England, private firms, GPs and voluntary-sector providers will be able to bid for a number of pathways, including musculoskeletal, respiratory and elderly care, collectively worth more than £300m.

A BMI Healthcare spokesperson declined to give specific details of any bid, but said the company ‘welcomes the opportunity to expand its service offering to NHS patients in [the East of England]'.

Dr Steven Laitner, NHS East of England's associate medical director, a GP in St Albans and an adviser to the QIPP Right Care programme, said he faced a fight to win the backing of GPs: ‘The PCT commissioners are on board with this, but GP commissioners have anxieties over competition and testing the market. A lot of them would rather work with existing providers, but that approach won't deliver the transformation of care we need.'

Dr Brian Balmer, chief executive of Essex LMCs and a GP in Chelmsford, said: ‘A lot of our GP commissioners don't know anything about these plans. The SHA's commercial wing these days is very, very ambitious. They are keen to be the first to do these dramatic things that could see us turn into an American-style health service that we can't afford and that will harm patients.'

11/8/11 - This article has been amended. Originally it said NHS Calderdale would tender out 'intensive care' beds. This has been corrected to 'intermediate care' beds.

How private firms could run NHS care pathways

NHS East of England's plan was inspired by a rheumatology pathway run by a GP-led private company in Oldham. Under the plans, the winning bidder will be charged with running an ‘integrated hub' offering care in the community to reduce hospital admissions, covering all treatment except ‘specialised hospital care'. It will be able to sub-contract NHS or independent providers to offer treatments within the service, but will take on all accountability for the whole care pathway.

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