Commissioning

STP progress ‘threatened by poor track record’ of private partner

Patient representatives and the BMA have voiced concerns over what they believe are “short-term commissioning decisions” after the Nottingham & Nottinghamshire sustainability and transformation partnership (STP) decided to hand a multimillion deal to a private firm.

Both the union and Healthwatch Nottinghamshire said short-sighted commissioning deals and the appointment of “controversial” private giant Capita could damage the progression of the transformation plan – but the STP hit back at these claims, arguing the company’s involvement has been gravely misrepresented.

The Nottingham & Nottinghamshire STP, one of the regions chosen by Simon Stevens to become an accountable care system (ACS), awarded a contract worth almost £3m to Capita, who has been repeatedly blasted by doctors and MPs for its poor track record in delivering and handling primary care services. NHS England itself has admitted that the company’s performance in providing support services to GPs was unacceptable.

The firm has confirmed it will be sub-contracting Centene UK as part of the deal. According to the STP, Centene UK specialises in systems and pathways and is not a healthcare provider; instead, it will provide specific advice on the logistics of developing new shared service models and information management & technology, with the work paid for by NHS England resources.

Yet Michelle Livingston, interim CEO of Healthwatch Nottinghamshire, said she shared public concerns regarding the development and implementation of the ACS in the region, particularly in relation to Capita’s delivery record and “potential further privatisation of the NHS”.

The regional Healthwatch has raised “a number of concerns” directly with the partnership’s leaders in the STP Advisory Group about how the “transparency, engagement and understanding of the ACS is far lower than we would hope it to be”.

“We have also raised concerns that short-term commissioning decisions are not supportive of, and could damage progression towards, the overall aims of the STP,” added Livingston. “We recognise there is a great deal of positive change for people in our area and for the services detailed within the local sustainability and transformation plan. Going forward we will continue to be both challenging and supportive of STP leadership team to ensure that there are effective engagement plans in place and to promote a meaningful consultation process about proposed changes to local services.”

The contract was handed to Capita late last month in order to help turn the STP into a more formal health body. The BMA reported that the company will be mainly involved in the assurance work needed, but sub-contractor Centene UK will allegedly be the ‘boots on the ground’ in developing the ACS by using its experience in delivering similar work in Spain.

The union’s East Midlands regional council chair, Peter Holden, blasted the firm’s “frankly appalling” reputation amongst doctors. “This seems, in some ways, to be a real kick in the teeth for the profession,” he argued at the time.

STP: Company involvement has been misrepresented

But Dr Stephen Shortt, lead for the ACS in Greater Nottingham, said the organisation has already written to all its local GPs to clarify Capita's role in “managing a competitive tender that was awarded to Centene UK recently”.

“The role of Capita in the competitive procurement process for this contract has been misrepresented,” stated Dr Shortt. “CCGs routinely procure commissioning support via a central list of accredited providers on the NHS Lead Provider Framework. As a ‘prime provider’ on this framework, Capita supported the tender process and effectively acted as link between the transformation partnership and Centene UK.

“The Nottingham and Nottinghamshire NHS has an excellent track record of working together to deliver results, which is one of the reasons we were picked to pilot this new way of working. Going forward I am hopeful that transparency and meaningful engagement will clarify the aims of the ACS as well as allow clinicians and patients to take an active role in defining the healthcare system they want to see in the future.”

In a separate statement, the ACS leader added that the contract provided a unique opportunity for Greater Nottingham to give people “a more joined-up experience of healthcare, hospital care, mental health care and social care that better meets their needs locally” and makes best use of available cash.

“We’ve identified ways that all of our organisations can begin to work as one system – with fewer barriers between services from the NHS, local councils and health providers – to ensure people are able to lead happy, healthy lives and to stay independent and well, and where possible receive care closer to home in the community,” explained Dr Shortt.

“The scale of transformation is unprecedented in England, but it has been achieved by health systems in other parts of the world such as Europe. That’s why we have to take this opportunity to learn from organisations with international experience of transformation, such as Centene’s work with Ribera Salud on the internationally renowned Alzira model in Valencia, Spain.”

The ACS worked with Centene UK during 2016 to identify ways that the different organisations in the STP catchment could be brought together.

“We believe this is the right approach. To give us the best chance of success, we have to work with people who have real-life experience of doing this on a scale and at a pace that hasn’t been achieved in England before,” argued Dr Shortt. “We don’t have all of this expertise within our own teams – that’s why we want to work closely and learn from others. Over time we will develop our own levels of expertise and knowledge and become more self-sufficient.”