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February 1 2007 - Hillingdon primary care trust in London may become the first to hand over almost all its core functions to the private sector, including the commissioning of millions of pounds of care for National Health Service patients.

By Nicholas Timmins,Public Policy Editor. FT

Published: February 1 2007 02:00 | Last updated: February 1 2007 02:00

Hillingdon primary care trust in London may become the first to hand over almost all its core functions to the private sector, including the commissioning of millions of pounds of care for National Health Service patients.

The move, which is likely to provoke bitter opposition from the health service unions, would see the private sector taking over not just the provision of community services but the assessment, planning, contracting, procurement and performance management of £258m a year's worth of health care for its local population.

The primary care trust would retain a few core functions, including patient and public involvement, emergency planning and the handling of contracts.

The move would be a big step towards the government's goal of turning the NHS primarily into a commissioning organisation. Provision in future will come from a mix of foundation hospitals, the private and voluntary sectors and social enterprise, but with the independent sector able to take part in the commissioning of care as well as its provision.

The trust yesterday in-sisted the proposal was only one of a number of options that would be put to the board in April. Anthony Sumara, Hillingdon PCT's interim chief executive who was brought in to troubleshoot one of the NHS's worst financial problems in London, was not available for comment yesterday. But he told the Health Service Journal that essentially, "I want to get rid of everything - outsource it".

The trust would not be giving up responsibility because it would remain the statutory body, responsible for the outcome of the contracts. It would reduce staff numbers from about 300 to about 30, he said.

Hillingdon has an accumulated deficit of £54m on its £258m turnover and has been projecting a further £11m deficit this year. According to papers put to the board last week, "outsourcing the majority of commissioning functions . . . gives the greatest probability of success" in turning that round.

He acknowledges, however, that having to pay off £54m in debt will make it difficult to draw up a contract from which private companies could make a profit, and that Hillingdon on its own may be too small to attract private providers big enough to take financial risk on the deal.

The NHS is negotiating a framework contract with big UK and US health providers that would allow primary care trusts to access anything from help with number crunching to the sort of "end-to-end" commissioning service that Hillingdon is examining.

Nigel Edwards, director of policy for the NHS Confederation, said a number of PCTs were considering enlisting private sector help with commissioning. "But I am not aware of anywhere else considering anything remotely this radical." With NHS commissioning in its infancy, drawing up such a contract would be "quite a challenge", he warned.