A new integrated care centre offering primary and secondary care, both NHS and private, to up to 30,000 patients has opened in Frome, Somerset.

The Frome Medical Centre will house 30 GPs and a number of consultants, offering GP care, NHS outpatient care and private care services.

The aim is to provide a ‘one-stop shop’ for patients in the town, removing the need for patients to travel further to hospitals and clinics.

The centre has been funded and developed by partners at the Frome Medical Practice, with each of investing £100,000 in the £10.5m project.

It will offer GP appointments and primary care diagnostic services, NHS outpatient services in minor surgery and mental health, and private pharmacy, optician, chiropractic and cosmetic surgery services.

The Centre’s building will also house a private GP practice, physiotherapist, podiatrist, acupuncturist and cosmetic surgeon.

Local GPs are expected to commission services at the new Centre, reducing the pressure on local hospitals.

Tina Merry, senior partner at the Frome Medical Practice, said the new centre has an “integrating agenda” focused on “developing services closer to home”.

“Secondary care consultants will come in here, and we will be able to work alongside them and work on pathway development to make sure we’re more integrated,” she noted.

The major private companies that provide NHS services are financially unstable and liable to pull out of their contracts.

A study by The Guardian found that of the six major private health providers involved in the carve-up of the NHS, three are already in crisis and none has a reliable financial basis.

Ramsay Health Care, Virgin Care, Harmoni, The Practice, Circle and Care UK all depend on parent companies or private equity investors, which have no obligation to maintain any loss-making enterprise.

Lack of profit from some NHS service contracts has already taken The Practice, Harmoni and Circle into financial crisis as service providers.

The Guardian analysis summed up the problem: “those who provide the care for patients are not the ones who decide whether that care can continue to be provided.”

Ramsay Health Care and Virgin Care depend on the investment of parent corporations that have widely varied interests, and the other four leading independent providers of NHS care are dependent on private equity investors.

In both cases, this is not a relationship traditionally associated with long-term consistency of service provision where profit margins are low.

The analysts predict that as the NHS struggles to cut costs, these providers will be caught between a demand for increasing profit and a demand from the NHS for lower operating costs.

Harmoni has already withdrawn from health provision, selling to Care UK in December 2012.

Circle, the first private health provider to take over an NHS hospital, has seen Hinchingbrooke Hospital in Huntingdon lose £4m in six months – double the rate it had forecast. The company’s high-profile Chief Executive, Ali Parsa, has resigned.

The Practice has withdrawn from many service contracts it took over from United Health. In early 2012, GP practices run by The Practice in north London, Nottingham, Leicester and Woking were shut down, without consultation, because they were loss-making.

The analysts conclude that transparency and continuity of service provision are liable to be compromised by such arrangements.

The National Health Action party, which opposes the coalition’s NHS reforms, aims to stand 50 candidates in the next General Election.

Founded by BMA council member Dr Clive Peedell, the NHA is also critical of the market reforms of previous Governments, arguing for a unified and publicly owned NHS.

The NHA is not allied to the Labour Party or to any left organisation: it seeks to defend the NHS in isolation from broader political or economic issues.

Peedell, a consultant oncologist, traces NHS privatisation back to the 1990 NHS and Community Care Act, which separated purchasers from providers.

Speaking to The Guardian, he said: “We are going to see the NHS shrink to a rump service and everyone else forced to pay top-ups in the future.”

According to the NHA’s analysis, key aspects of NHS reform are designed to lead to privatisation: shifting healthcare to the community will make it easier for private providers to enter the NHS market, while personal health budgets will open the door to charges for NHS services.

Peedell does not accept the argument that the NHS was integral to the postwar socialist agenda: he argues that it lasted within a market-driven society for 60 years, but more recently the three major parties have irrationally undermined it.

The NHA aims to target 50 Parliamentary seats held by coalition MPs who supported the Health and Social Care Act.

However, an analysis by Conservative peer Lord Ashcroft predicted that its campaign would keep Labour out of power.

The Department of Health (DH) has abandoned plans to use the Payment by Results tariff to stop private health providers ‘cherry-picking’ the easiest cases.

The decision breaks with a DH commitment made in November 2011 in response to the Government’s ‘listening exercise’.

However, the decision to deal with cherry-picking by “strengthening guidance” to providers has been positively greeted by the BMA and the King’s Fund.

Concern over private health companies contracted to provide NHS services selecting only the most profitable cases dates from the previous Government’s Independent Sector Treatment Programme.

It was a key concern among critics of this Government’s NHS reforms, leading NHS Deputy Chief Executive David Flory (pictured) to promise that using the tariff to discourage such behaviour would ensure “transparency and fairness.”

However, Flory recently informed NHS managers that the DH no longer planned to use tariff payments for this purpose.

“After extensive consultation and advice by the experts we believe that strengthening guidance around Payment by Results is a more effective way of preventing cherry picking,” said a DH spokesperson.

The BMA commented that using the tariff might not have solved the problem and “could have been interpreted as opening the door to price competition”. The “underlying problem” was “market reforms”, it said.

Nigel Edwards, Senior Fellow at the King’s Fund, said the tariff plan had been naive: “Pricing isn’t subtle enough to take into account all the complications of risk.” He argued that retrospective price adjustments might be more effective.

A Labour Government will rebuild the NHS as “a national, planned, collaborative system”, according to Shadow Health Secretary Andy Burnham.

In a preview of his party conference speech, Burnham promised to end the ‘any qualified provider’ (AQP) policy, which he said is now causing wholesale NHS privatisation.

More controversially, he outlined plans to have local authorities lead NHS commissioning and NHS hospitals provide social and mental health care.

Pledging a return to the NHS as ‘preferred provider’ of services, he said the private and voluntary sectors would “play a supporting role to a publicly owned, publicly accountable NHS”.

Burnham noted, from information about NHS tenders obtained through freedom of information requests, that the AQP rules now in operation were leading to rapid privatisation of many NHS services.

“This week the AQP contracts are being signed with private companies,” he said. “It is very difficult to find out what is going on. Who they are, how much is being spent. They cite commercial confidentiality but that is not good enough.”

In particular, he argued, hospitals reserving up to 49% of their beds for private patients from 1 October will “damage the character and culture” of the NHS.

While Labour did not intend to exclude the private sector from NHS service provision, he stated, it would remove the new “competitive structure” that hospitals and providers “have to work within”.

To achieve this, it would replace the CCGs with a commissioning system led by local government – retaining local control but removing the commercial element.

In addition, instead of reducing the role of hospitals, Labour would involve them in providing social and mental health care for the most vulnerable people.

Labour leader Ed Milliband has already pledged to repeal the Health and Social Care Act.

Maxine Vaccine asks whether the current horse-trading between health and social care is a version of trading in derivatives. How much of this theoretical money ends up providing real care?

Everyone supports the principle of integrated care. The more closely healthcare and social care teams work together, the more effectively the needs of communities – and especially, the growing elderly population – can be met. Putting local government in charge of public health aligns it with social care, strengthening the role of both services in promoting and protecting health, and thereby reducing the clinical and economic burden on the NHS.

That was the basis of Duncan Selbie’s recent statement that local government could make a better job of improving public health than the NHS. The new head of Public Health England was arguing that councils have “a much broader view of the world” through their long-term role in such functions as education, housing and sanitation. Some might question, of course, whether councillors – who owe their jobs to the murky world of local politics – can really compare with a workforce of dedicated health specialists. But in principle, public health can only benefit from being seen in the right context: the actual lives of communities, where and how people get along from day to day.

The problem starts when you ask: who is investing in the social care that will provide the basis of a stronger public health strategy, while reducing the burden on the NHS? That has been a major concern from the early days of this Government, which declared it would not reduce NHS funding but then conceded that the NHS would have to make up for the drastic cuts in social care funding. If you spread salmon paste too thin it becomes tuna. If integrated care means passing the buck of austerity obsessively back and forth between CCGs and councils, all that will be shared is pain.

Just as the DH has drafted legislation that will force CCGs to give contracts to private sector health providers if the latter tick ‘efficiency’ boxes defined by the Government, it has drafted legislation to expand the market for private sector providers of social care – and backed it up with the Developing Care Markets for Quality and Choice programme, which helps local authorities to shape the social care market.

Meanwhile, the Dilnot proposals for enabling more elderly people to afford the care they need have become a political liability. The Government has expressed support for the principle of capping individual contributions, but will not commit to a figure or a funding mechanism for it. There is talk of funding it by cutting £2bn out of the NHS budget – which, understandably, has horrified the NHS Confederation. Finding a workable solution to the challenge of social care is hard enough for a government that believes the market can solve everything, without some pesky economist telling it to spend money.

And now former Social Care Minister Paul Burstow has accused George Osborne of trying to put the Dilnot proposals “in the trash bin”. I’m gutted that he has not provided photographic evidence of this. Burstow claimed that detailed plans were drawn up to implement the Dilnot proposals, but Osborne refused to sign off the funding. He also accused his own leader of having failed to recognise the popular support that Dilnot commands.

Of course, Burstow was speaking during that surreal week in the LibDem calendar when the party exchanges the Orange Book for the Little Red Book in an attempt to convince its membership at conference that it believes in ‘liberal’ values. Like Clegg’s talk of a mansions tax, Burstow’s accusations of a Dilnot-dustbin interface will shortly be forgotten when the LibDems resume their coalition role of voting through everything the Chancellor suggests.

All this talk of social care reform, public health reform and (let us not forget) NHS reform helps to keep the private sector interested in the services that are currently being franchised. The funding promises and the ‘partnerships’ they attach to are closely allied to the derivatives that keep ‘wealth creators’ involved in finance. The more the money goes round from the NHS to local government and back again, the more can be hived off into the accounts of investors – and the less there is to pay for actual care. Whether it’s healthcare or social care doesn’t matter when the game is austerity: nothing split two ways still doesn’t come to much.

Maxine’s views are not necessarily those of Pharmaceutical Field.

The UK Government has decreed the risks of NHS reform to be a state secret. Maxine Vaccine looks at what the veto on publication of the NHS transition risk register is covering up.

Yesterday’s news is really the WTF to end them all. Having lost two legal battles in its attempt to keep Whitehall’s statement of the risks of the Health and Social Care Bill from meeting the public eye, the UK Cabinet decided to impose state secrecy legislation designed for use in times of war.

This means that the transition risk register, written to advise ministers on what could go wrong with what Sir David Nicholson called “the reform so big it can be seen from space”, will never be published. Its publication would be a crime on a level with the disclosure of state secrets to a military enemy.

According to Andrew Lansley, this “exceptional” measure is necessary to safeguard the policy-making of the future. If the risk register were made public, he claims, all such documents would have to be watered down for public consumption. In other words, our democracy cannot afford transparency even on health reform.

However, the risk register was briefly leaked online last month – so we already know that it predicted a significant risk not only of increasing health inequalities and gaps in service provision, but also of a systemic breakdown of the health service as such.

What kind of breakdown? The kind where a disorientating shift in health service management and responsibility runs into steep funding cuts – and the system breaks apart like a poorly manned sailing ship in a hurricane, leaving millions of people without access to any but the most basic services.

What would happen then? Firstly, Foundation Trusts struggling to keep afloat would be assessed as having failed economically, and taken over by private health providers such as Circle. That has started to happen already, but a breakdown of the system would make it endemic.

Secondly, the new CCGs would be unable to juggle the priorities of health service management with severely reduced funds, and – with the private sector already in charge of their data and administration – would have to surrender their decision-making to private health providers.

This is surely what Lord Howe had in mind when he commented in 2010 that he did not expect GPs to become managers, and that the GP consortia would depend on “their private sector partners” for commissioning functions.

It’s also what former NHS Chief Commissioner and current Government health advisor Mark Britnell had in mind when he told a conference of private healthcare companies back in 2010: “The NHS will be shown no mercy, and the best time to take advantage of that will be in the next couple of years.”

That’s why Andrew Lansley, as the Health Bill was about to become law, abandoned any pretence that the legislation was about “empowering clinicians” and, as every organisation representing clinicians in the UK told him the Bill would damage the NHS, responded with the supreme indifference of a village squire witnessing the Peasants’ Revolt.

And for pharmaceutical sales professionals trying to identify where the new NHS customers are, the message is pretty clear. Your immediate customers are standing, as a GP recently put it, “baffled in the ruins” of the NHS. But your longer-term and most important customers don’t spend much time around here. Their companies are based in the US and Germany, and they are closing in on the NHS like sharks around a harpooned whale.

Maxine’s views are not necessarily those of Pharmaceutical Field.

The NHS Technology Adoption Centre (NTAC) has launched a new online system to help NHS and private health providers adopt proven medical technologies more quickly and effectively.

The new Generic Adoption Process (GAP) provides a detailed roadmap of the adoption process and access to the tools and resources needed.

GAP builds on the experience of NTAC’s Technology Implementation Projects over the past four years in improving the diffusion of proven medical technologies across the NHS.

Users of the GAP website are encouraged to navigate through each of its sections in order, thereby building relevant knowledge – however, they are free to navigate between sections as they wish.

The site is designed for use by health providers at all stages of the technology implementation process.

Sally Chisholm, CEO of NTAC, commented: “GAP has been tested by a number of key stakeholders from the NHS and industry. We believe this is a vital tool which will help drive widespread adoption of proven technologies, as GAP can provide unrivalled knowledge and information to those who do not choose to directly engage with NTAC on an implementation project, for example.

“The idea for GAP came from our recognition that there is a clear need for something which can equip clinicians, managers and other key stakeholders crucial to service development with the tools and resources they need to be able to drive change and innovation throughout the NHS.”

NTAC takes the view that the NHS often fails to adopt innovative medical technologies whose clinical and economic value is proven due to a lack of well-resourced and coordinated adoption pathways.

GAP is available at http://www.ntac.nhs.uk/GAP/GAP_Home.aspx