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Warning over divorce of commissioner and provider roles

PCTs are being warned to think very carefully before washing their hands of providing services for fear this could have negative implications for PBC.

By Emma Wilkinson

PCTs are being warned to think very carefully before washing their hands of providing services for fear this could have negative implications for PBC.

In a drive to ensure there is no conflict of interest and competition prevails, PCTs are moving to divorce from their provider function and become solely commissioning organisations.

But a new NHS Alliance report, Provider Services and PCTs, warned trusts against a hasty divorce.

The options for the PCT are to hive off the services they provide – such as community district nurses and health visitors – into a stand-alone trust, allow services to be taken over by a foundation trust, or keep the services in-house.

Report author Dr Donal Hynes, vice chair of the NHS Alliance, told Practical Commissioning: ‘Anybody who can contribute to the NHS is likely to have a conflict of interest. If they don't, they are likely to be so removed that their contribution has no value.'

He argued keeping provider services in-house had benefits and was acceptable provided the divide between the PCT's provider and commissioning teams was made clear.

Keeping teams in-house would also make it possible to enhance existing services rather than having to commission a new service from scratch.

Dr Hynes said: ‘Rather than having to spend a year trying to build up a tender, you can ask the PCT provider to trial the service, so it gives much greater flexibility.'

He added: ‘The emphasis is now on case management and this is much easier to build up with a workforce that is part of the organisation rather than completely separate.'

It comes as two PCTs in the North-East announced the transfer of staff to the local foundation trust.

In what is thought to be the first move of its kind, Hartlepool and Stockton on Tees PCTs agreed in January to become solely commissioning organisations. They have now moved 856 staff to North Tees and Hartlepool NHS Foundation Trust.

This will be their home for 17 months while the PCTs carry out service reviews and market testing before inviting tenders to run community services.

Dr Nav Chana, executive board member of the NAPC, said separating commissioning and provision did not fit easily with the idea of integrated care.

‘It's nice to be able to articulate that you're not creating a monopoly but there are drawbacks and loss of integration is one of those.'

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