Up to 10 trusts will be established as pilots over the next 12 months to deliver community services currently run by PCTs. They are likely to span more than one PCT area each. No detail about their location has been revealed. They will be paid on a block contract basis at first, but could move eventually to a tariff-based pay system.
GPs fear community foundation trusts would compete to provide GP services. GPC chairman Dr Hamish Meldrum said he would be concerned if the DoH ‘rigged the market’ to help the trusts develop this role: ‘If it is a level playing field, I am confident GPs can compete,’ he said.
GPs warned that existing organisations should be allowed to bed in before the NHS was subjected to further change. The number of PCTs in England was cut from 303 to 152 in October.
Former NHS chief executive Sir Nigel Crisp proposed separating PCTs’ provider and commissioner functions by creating a patient-led NHS in 2005. But the DoH backed down after widespread opposition.
However, DoH director general for provider development Andrew Cash told the NHS Alliance conference in Bournemouth last week: ‘For the next 12 months, there will be five to 10 pilots to see if community foundation trusts work. They will not be coterminous with existing PCTs.’
Foundation trust regulator Monitor backed the proposals. Chairman Bill Moyes said it would assess whether it could apply the monitoring process used for secondary foundation trusts to the community trusts.
‘We looked at trusts and decided they could operate on that basis. Our recommendation to health minister Lord Warner has been to get pilots going, with senior management teams in shadow form,’ Mr Moyes said.
‘By April 2008 they would have a track record and could start the process of authorisation.’
NHS Alliance chairman Dr Michael Dixon said: ‘This will create a division in the NHS.’
He said community foundation trusts were likely to end up in opposition to commissioners, pushing for more work as commissioners tried to make efficient use of resources.
‘If they are like acute foundation trusts, they will not be clinician led, and if they are larger than PCTs they will not be locally responsive,’ he said.
GPC negotiator Dr Richard Vautrey said: ‘A huge organisational change must be allowed to bed in.’
He said the proposals would reinvent the community and mental health trusts from almost a decade ago.