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The plans outlined in the Equity and Excellence: Liberating the NHS white paper have given NHS organisations a lot to think about. Among other things, abolishing primary care trusts (PCTs) and strategic health authorities and handing commissioning to GP consortia means that shared programmes of work are particularly vulnerable to change.
Health secretary Andrew Lansley's changes will take place pretty quickly: GP commissioning consortia will appear into shadow form in 2011-12 and will hold contracts with providers by April 2013. SmartHealthcare.com examines the specific impact on two key areas: back office shared services and local co-operation under the Total Place programme.
Back office services
NHS Shared Business Service (SBS), a 50/50 partnership between the Department of Health and Steria, currently provides shared services including finance, payroll and other technology to more than 50 primary care trusts – organisations that will be abolished in a few years' time.
But despite its large PCT clientele John Neilson, managing director of SBS at Steria, sees the changes as a great opportunity – while admitting that it is hard to judge the exact impact.
"I think it's difficult to say precisely what it means, but we're very much looking at this as a glass half full sort of perspective at the moment. They (PCTs) still need to save a lot of money and there are still two and half years to go until they're abolished so there's money that has to be saved in that period. Clearly if they don't start soon they're going to run out of runway to actually save in that time period," he says.
Neilson says that since the first round of government cuts were announced and the NHS reforms were outlined, interest in SBS has "jumped up quite dramatically". "We expect that to continue and I'm hoping that with prospective PCTs it will accelerate," he adds.
"I actually think that there is quite a short window. If they haven't done something within in a year, clearly the benefits of cost saving are going to be much less and actually it might be much harder for the (GP consortia) clusters to make any decisions when it comes to that point when it is time for service."
Much is being made of the power that will be given to GP consortia and whether the transition will go smoothly, which will be dependent on the number of clusters that emerge. Neilson isn't too concerned about the numbers and believes that the SBS model can be applied to individual GPs and consortia. He says that it will be in their interest to use the service.
"The GP consortia may or may not have access to the different supplier arrangements that PCTs have, so whether they're ordering anything from pencils to syringes to bandages to whatever, if they can take advantage of existing or in fact new regional or national supply contracts, then that has got to be in their advantage to do that," he points out.
Victor Almeida, healthcare analyst at Kable, agrees with Neilson that the reforms could provide substantial opportunities. "Procurement services will provide a growing market, as GPs with limited experience in the field turn to external suppliers with strong credentials," he says.
But he warns that technology suppliers should note that performance and procurement are becoming intrinsically linked, adding that many procurement frameworks will now be supported by various quality standards.
Total Place
Giving more power to local authorities and scrapping PCTs will undoubtedly affect the Total Place efficiency initiative, set up under the former Labour government but still in its early stages. Launched in July 2009, it promotes shared working between local organisations such as councils, PCTs and police forces, with 13 areas participating in pilots.
John Tizard, director of the Centre for Public Service Partnerships, an independent researcher that has advised Worcestershire on its Total Place pilot, thinks the government's reforms could present some challenges.
"Every local authority has a partnership relationship with its PCT or PCTs. That relationship has obviously been built up over a period of time. It will be based on maybe institutional and personal relationships and any move to fragment one of those partners is going to put a strain on collaboration and partnership working," he says.
Tizard believes that the proposed GP consortia should be obliged to work in partnership with other agencies. He says that consortia may focus too much on health, rather than relationships with other local organisations.
"The GPs are all set to be small businesses that are looking to maximise their business outcome and may not therefore have the wider, and I stress may not, have the wider public interest the PCTs have," Tizard adds. He also acknowledges that there are some "extremely good" GP practices working in the community sector, but says the government must take note of the risks.
Critics of the new government have said that it has not paid close enough attention to Total Place. Tizard agrees that "it is not what you hear Eric Pickles and members of the current government talk about".
Leicestershire is hosting one of the Total Place pilots. Andy Robinson, assistant chief executive of Leicestershire County Council and local leader of the project, believes the increase in the local authority role outlined in the white paper "helps in a Total Place context".
"It'll certainly change the way we do things, but we don't see any of that as being dramatic as such. On the GP sides of things we'll be working with one or more GP clusters rather than the PCTs so there will be more people to work with in that sense, but we don't think the focus of that activity will change," he says.
Robinson disagrees with John Tizard on the potential behaviour of GP consortia. "There are no indications that GPs will have a less positive attitude to that than the PCTs have, so then of course the local authority has this role to co-ordinate health social care and well being activity," he says. "That's a role I think that Leicestershire would see itself playing in terms of democratic accountability and ensuring that we can join things up across the place."
Tizard believes that some form of collaborative working "is inevitable" once the NHS reforms are in place. "We hope that the coalition government facilitate that rather than just allowing it to happen circumstantially area to area," he concludes.
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