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Therapists and nurses to discuss co-ownership

Physiotherapists are involved in plans to form their own company and sell their services back to the NHS

Therapists and nurses are at the forefront of plans to create a new primary care service provider which has prompted questions about the future make-up of the NHS.

Around 750 staff in therapy and nursing teams at East Elmbridge and Mid Surrey primary care trust are being consulted about transferring to a new social enterprise in which they would become co-owners.

The new body, Central Surrey Healthcare Ltd, could be up and running next April, competing to provide £22 million worth of services to local commissioners.

The Department of Health is taking a close interest in the model, which would see the first large-scale transfer of key NHS services to an employee-organisation.

But the CSP is advising its members to consider any proposals closely before deciding whether to back a plan which it says would put them outside of the NHS.

Discussions are under way with staff after the PCT board gave backing in principle in July for Central Surrey Healthcare to be set up as a not-for-profit company.

The new business would look to provide services via the specialist personal medical services contract, similar to contracts used by GPs in primary care.

Architects of the scheme say they are acting in response to uncertainty about the future outlook for services if the PCT's financial circumstances worsen.

Jo Pritchard, joint clinical lead for the project, said operating as a limited company with legal service contracts was the best way of guaranteeing 'organisational stability' and would put health professionals at the heart of decision making.

'They will be able to use their skills to ensure maximum benefits for patient care,' she said.

Central Surrey Healthcare plans to establish a 24-hour nursing and therapy service and ensure more patients are treated by community teams.

PCT staff moving to the new firm would have their job terms and conditions protected under established regulations governing the transfer of employees.

But it is thought unlikely staff will sign up to the venture unless solid guarantees can be given that NHS pension rights will also remain intact.

Employees would become shareholders in the enterprise although it is understood operating rules would prevent them cashing in or profiting from their involvement.

The CSP says it advises members to be 'extremely cautious' about entering into alternative models of service provision without full evaluation of potential gains from these models compared to existing provision.

But the Society says it has not been provided with a full business plan to carry out a formal evaluation itself.

Mike D'Arcy, the CSP's trade union representative for the South East, said it appeared at this stage a majority of staff were in favour of the plans.

'But I'm not too sure they realise they are going to be completely outside of the NHS,' he told Frontline.

He said staff would need water-tight assurances on service contracts, in the short and long-term, to ensure the company had cash-flow to pay them and run services.

He added: 'There's no question that when the contract comes up for renewal they will be competing with other providers. Although they may have an advantage in the market with their knowledge and skills, there's no guarantee somebody else like Bupa or another big company won't take over in due course.

'There's also no guarantee from the government that competition will be restricted to social enterprise community interest companies.'

If the PCT board approves the proposals in January, formal consultation will begin under the Transfer of Undertakings (Protection of Employment) Regulations (TUPE).

Mr D'Arcy said: 'We know the new company would have to take on board Agenda for Change, but we don't have a guarantee at the moment that they would honour future agreements.'

He has met with Tricia McGregor, former therapy services manager at the PCT and now joint clinical lead for Central Surrey Healthcare.

Neither Ms McGregor nor Jo Pritchard would respond to Frontline requests for an interview.

Central Surrey's spokesperson Louisa Stanton said she hoped to provide an update in two weeks' time 'when there is something solid to share'.

Mr D'Arcy intends to speak with staff en masse when more details are known.

Richard Stacey, a physiotherapist at Epsom General Hospital and a staff side representative, told Frontline: 'We can't believe we're the first organisation to do this. So it's possibly a little bit daunting.'

He added: 'We've started to look at the feasibility, whether the organisation is likely to be successful and whether the staff are going to agree to go into that type of organisation.'

Mr Stacey said he felt staff were being kept informed and made aware of risks associated with the venture, although more detailed discussions were needed and still to take place.

He added: 'They are aware of a risk if we're to lose contracts. Possibly there are vulnerabilities within the new organisation such as outpatients services for physio might be vulnerable to private practitioners.'

But he said colleagues would have to weigh the proposals against the risks of staying with a PCT facing heavy financial pressures.

He told Frontline: 'The alternative is we could be fragmented into little organisations. There are risks with this new organisation but there's also risks with staying within the NHS and coming under the structures of other organisations where they might not see therapies as their core organisation.'

He added: 'One of the things we've got in terms of strength is that we are a group and we can be more flexible as to how we move staff in rotations and training and development.'


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Matthew Limb

Issue date

7 December 2005

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