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A key element of Department of Health (DoH) policy over the last five years has been the separation of Primary Care Trust (PCT) commissioner and provider functions, with the aim of focusing PCTs on their commissioning role. The transformation of community services in accordance with both the DoH’s January 2009 guidance 'Transforming Community Services: Enabling New Patterns of Provision' and its February 2010 guidance, 'Transforming Community Services: The assurance and approvals process for PCT-provided community services' was an important driver in achieving this goal.  Now, with the 2010 Health White Paper, there is a universal obligation on all PCTs to externalise all their community services provision and to have this process completed by 31 March  2011.

The most likely options for organisational forms are:

• Vertical Integration (with an acute or mental health provider)
• Horizontal Integration (with another community provider)
• Social Enterprise

Exceptional options may be Community Foundation Trusts (CFTs), only for a very few areas, or Care Trusts. Regardless of the organisational form the Transforming Community Services (TCS) guidance made clear that 'PCTs should principally be commissioning organisations'. Now that PCTs are to be disbanded (no later than April 2013), commissioning itself will be transferred to GP Commissioning Consortia.

Our Expertise

We have been advising about transforming community services and the separation of commissioner and provider functions since 2006, when we co-authored with the Health Services Management Centre (University of Birmingham) the report Options for primary care trust provider services: an evidence-based policy analysis for NHS West Midlands. Since then, we have been advising a range of clients on implementing the TCS agenda. Examples of our recent work include:

• Vertical integration: the transfer of the community services of NHS Barking and Dagenham to North East London NHS Foundation Trust, which was the first such transfer to be assessed by the Co-operation and Competition Panel, and the transfer of the community services of Stockton-on-Tees Teaching PCT and Hartlepool PCT to North Tees and Hartlepool NHS Foundation Trust, which was the first such transfer in the country.
• Horizontal integration: the ground-breaking £23m deal which will see a brand new community hospital built in Selby in conjunction with a new Civic Centre, through a joint venture between the Council and the PCT.
• Social enterprise: the establishment of social enterprises by PCT staff under the Department of Health’s ‘Right to Request’ policy.
• Community Foundation Trusts: the development of CFTs in response to the TCS agenda.
• Integrated care models: including involving polysystems and PbC.

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