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Elderly care pathways hived off in first major pilot of new NHS market

By Ian Quinn

Exclusive: NHS managers have approved plans for entire care pathways for elderly patients and those with respiratory and musculoskeletal problems to be put out to tender, in a radical expansion of market forces in the health service.

This plans – signed off by NHS East of England – will hand private firms, NHS providers or acute trusts a fixed amount of money, creating an ‘incentive’ to increase profit margins by delivering cheaper care out of hospital for frail and elderly patients and those with respiratory and musculoskeletal problems.

Pulse exclusively reported earlier this month that NHS East of England was drawing up proposals for a radical expansion of the market, although the names of the trusts involved were being kept tightly under wraps.

This week the SHA confirmed it had given the go ahead for NHS South East Essex to launch a competitive tender process for its entire musculoskeletal care pathway and NHS Luton is also set to go to the market for NHS and private firms to take on its pathway for frail and elderly patients.

Subject to more detailed business cases being approved by PCT boards and GP consortia, the plans, seen by leading NHS figures and the Department of Health as a potential model for the rest of the country, will be expanded to cover a range of other clinical areas.

A spokesperson for the SHA said: ‘As soon as possible, the market will formally be invited to express an interest in participating in these pilots with a view to contract signature by early 2012.’

Dr Stephen Dunn, director of project development and strategy at the SHA, said the way NHS services were designed needed to ‘radically change’ and said it would now start drawing up details economic proposals and to launch a major consultation with GPs.

‘The next phase is to work up the business case and go through the consortia engagement process,’ he said. ‘This is not a management solution . It’s a solution to develop QIPP and it’s been led by GPs but we need to make sure that GP consortia want it.

‘Pathways are going to need to radically change but the economics need to stack up.’

Dr Dunn described the proposals as ‘hugely innovative and exciting’ and said the SHA had been involved in discussions with the Department of Health about the potential for a far wider rollout of the model.

‘They are interested,’ he said. ‘ People have talked about this sort of idea nationally, even internationally but nobody has got to where we’ve got.

‘East of England is leading the way. I think the Department of Health acknowledges that but they are keen to ensure that it’s consistent with their policies. There are some concerns that this is an outsourcing of commissioning and it’s absolutely not.’

The most controversial part of the plan for GPs looks set to be a potentially wider role for the private sector, with East of England having already held a string of talks with firms to gauge their interest.

‘We’ve had informal meetings with everyone from acute trusts to community organisations, social enterprises, the independent sector and GPs,’ said Dr Dunn.

Last week the King’s Fund called for entire care pathways to be outsourced to external providers, including private firms, claiming GPs do not have the resources to make the required changes to services demanded by the Government’s NHS reforms.

The influential think tank says GP consortia should look to devolve responsibility under proposals that would see external providers offered financial rewards and take on the financial risks for re-designing NHS services.

Care for frail and elderly and patients and those with respiratory problems first to go