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Acute sector to take iron grip on community health services

By Ian Quinn

Exclusive: Acute and mental health foundation trusts are set to take a stranglehold over NHS community services under the Government's cull of PCT provider arms, a Pulse investigation reveals.

Our survey of PCTs provides the most comprehensive picture to date of the impact of the Government's Transforming Community Services initiative, and reveals most trusts are planning vertical integration either with hospital or mental health trusts.

The findings, which also reveal a growing role for the private sector, have prompted concerns from GPs that community services could be left vulnerable to sweeping budget cuts. They come as GPs and patients took to the streets of London to campaign against radical reforms to the health service in the wake of the financial crisis

Pulse received responses from 48 PCTs, given until the beginning of this month to come up with proposals to shed responsibility for providing community services such as district nursing, urgent care centres and management of long-term conditions.

Of 30 PCTs revealing definite plans, exactly half had chosen to look at mergers with hospital or mental health foundation trusts.

Another seven, while opting for a mixture of options, had identified the acute sector as a new home for at least part of their community services, meaning almost three quarters of plans contain some element of vertical integration.

Four PCT s planned to hive off services to social enterprises and two to launch community foundations.

Just two PCTs plan to keep community services under direct PCT control - NHS Tower Hamlets, which has already won an exemption from the Government and NHS Cumbria, which hopes to do so.

Elsewhere in London the acute sector is dominating the process.

Ealing and Harrow PCTs have won competition panel approval for a merger of their provider arms with Ealing Hospital Trust, with the possibility Brent's provider arm could join them.

NHS West Midlands said it would consider putting two urgent care centres out to the private sector.

NHS Manchester will merge a raft of community services, including its learning disability and community matrons services, with two hospital trusts.

Dr John Hughes, honorary secretary of Manchester LMC, said local GPs were deeply concerned:

‘Hospital trusts are under huge financial pressure so there is a risk community services could be consumed. District nurses might be transferred to work in hospitals. Vulnerable children could be placed at risk because of lack of communication with GPs.'

Dr Kambiz Boomla, a GP in Tower Hamlets, said his local community health staff saw the decision to allow them to remain within the PCT as a ‘massive victory'.

‘What's happening elsewhere hasn't been thought through. It's madness to separate off services such as district nurses from GPs.'

Community services, such as dietetics, are being hived off to hospital or mental health trusts