The dust is beginning to settle on the new NHS organisational structure brought about by the Health & Social Care Act. Primary Care contracts have been transferred to NHS England, and the CCG’s are managing the other healthcare contracts. It has been a confusing and difficult time, but at least everyone now knows who is writing the cheques. Right?
In the first couple of months after April many practices have suffered a cash flow crisis while the new responsibility for contract payments has been sorted out. For many practices in PCT owned premises this has also included a new income and expense stream as they receive rent reimbursement payments from NHS England to be paid to their new landlord the NHS Property Company. The biggest surprise for some practices however, has been that not all their income comes from NHS England.
This is a brave new world to which all practices will have to adjust. Whilst the core GMS, PMS and APMS contract has transferred to NHS England, NHS England only have responsibility for national immunisation and screening programmes. What is more, there is a stated objective to move back towards a single national contract, which begs the question of who in future will be responsible for the additional services currently provided by PMS and APMS Contractors?
We believe the answer is the CCG. The CCG will become responsible for contracting many of the services that were previously provided as LES’s, as well as most other locally defined healthcare related services. Since most practices currently only have a contract with NHS England, they will have to enter into new contracts with their CCG to provide these additional services.
What is more, responsibility and budget for Public Health has been transferred to Local Authorities. In addition to information and advice, this is defined in the new Act as “services or facilities for the prevention, diagnosis or treatment of illness”. It seems likely therefore that at least some Councils in England will spend their new budget commissioning primary care services.
The challenge for practices will be that CCGs and Local Councils will be under enormous pressure to tender such contracts. Indeed they will be under an obligation to put all contracts up for tender unless there is only one possible provider of the service. Practices will therefore have to get used to tendering for contracts just to maintain their current levels of income, let alone bidding to provide new services.
We will be looking at how to bid for such contracts in a future article, but a summary of the new relationships is shown in the diagram below (click on image for higher quality):