Out-of-hospital care - our view

Care UK's response to the current review of out-of-hospital care is outlined by Dr Sushil Jathanna, Managing Director, Clinical Care Services.

As a leading UK provider of health and social care solutions, we welcome the review of out-of-hospital care and believe we, and the independent sector as a whole, can contribute towards achieving the aims of primary care reform. Our experience across primary, home, specialist and acute care mean we are uniquely positioned to develop services to meet local demand and to offer integrated health and social care solutions.

We aim, in the long-term, to develop expertise and partnerships across the full range of out-of-hospital care services, from replica GP services to comprehensive, innovative service networks with a far broader scope than traditional primary care. We have developed a number of innovative service models as part of this strategy.

Key objectives of our approach include focusing on the customer; a cost effective skill mix; triage from the first point of contact; separation of scheduled and unscheduled services; integration of health and social care; scalability; a focus on outcomes; and the ability to reduce reliance on the hospital system.

Matters that we believe require consideration in the review include:

• The regulatory system could better support competition and independent sector involvement. We welcome the Government’s intention to revise health and social care regulation from 2008 but caution that the emerging out-of-hospital care market needs regulating too

• Existing public sector provisions for staff transfer create a two-tier benefits system, inflate independent sector costs and decrease the attraction of independent organisations as employers. Competent bidders like Care UK could be priced out of contention if the playing field for independent and public sector providers is not levelled

• The practice regulation process should be revised to support the separation of scheduled and unscheduled care. GPs no longer have or need a monopoly of provision of first contact care

• We support patient choice but would need a critical mass of patients to sustain the mix of services we might provide. We have identified a number of options for balancing choice and demand risk

• The opportunity for vertical integration by foundation trusts needs to be carefully regulated in order to avoid the creation of local monopoly positions or expose primary care to asset stripping

• Regulation is required to deal with market entry and provider failure. Too many providers will fragment out-of-hospital care and inhibit scale economies and integration

The role of PCTs, with a new focus on commissioning, will be critical in the restructuring of services. Our experience suggests that education and training will be required to strengthen their knowledge of open market management, their negotiation skills and awareness of independent sector pressures. This article provides a brief overview about our vision for out-of-hospital care.

If you would like to comment or find out more about our plans, please contact .