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Radstats members are advised to find out what is being decided locally for the organisation and delivery of healthcare services. This is urgent. One model is for services could be delivered by private providers and the other options are not proven improvements. Janet Shapiro > PCTs all around the country must be deliberating (quietly) on the DoH > directive that would uncouple primary healthcare services. The TCS > document is dated January 13th, yet PCTs must make a decision in April on > an option for a model that gives a separation of commissioning and > provider functions. (This has already gone to an OCS in Enfield.) > > The new models have implications for patients in that there will be > disruption & likely fragmentation of delivery of services. Workers will > feel and be less secure and that in itself could also affect standards of > care. Yet nothing gets said in meetings. Why are there no protests about > the indecent haste for deliberations that make such fundamental changes? > > The main documents are listed at the end of this message, but the main > options in plainer language are given below. > > Transforming Community Services > Key points from Chapter 7 of the TCS Document: > Arms-length PCT provider units > PCTs may retain accountability for provider services by maintaining > services in a ‘provider unit’ within the organisation. They will need to > develop new governance arrangements that ensure a formal separation > between their commissioning and provider functions. This could entail a > provider services unit that hosts all PCT provider services, led by a > strategic provider board. > What this means for staff - staff would continue to be employed by an NHS > organisation, and as such be covered by the NHS terms and conditions and > negotiating machinery and have access to the NHS pension scheme. New > starters will be appointed on NHS terms and conditions and will be > entitled to join the NHS pension scheme. > Social enterprises > PCT staff can use their ‘right to request’ to set up a social > enterprise. PCTs will be obliged to consider requests and if approved by > the SHA, a contract for an initial three years will be given. > What this means for staff - TUPE transfer will protect existing NHS terms > and conditions, but staff will not be covered by the NHS negotiating > machinery and, as such, all future changes or improvements to NHS terms > and conditions and pay are not automatic. New starters will be on > organisation specific terms and conditions, which should be overall no > less favourable than the terms and conditions of transferred employees. > This right is enshrined in a Code of Practice on Workforce Matters > produced by the Cabinet Office covering the public sector as a whole. The > TCS guidance circulated by the Department of Health makes it clear that > the provisions of the Code must be followed. > Footnote 1 > Transferred staff will be able to stay in the NHS Pension Scheme, > providing they continue to deliver NHS funded work and the social > enterprise organisation is not bought by another non-NHS organisation. > This arrangement will not apply to any future employees of the social > enterprise - the social enterprise organisation will need to provide > access to a pension scheme for any new staff. > Polyclinics / GP-led health centres > Polyclinics or GP-led health centres > bring together family doctors, nurses, AHPs, specialists and other > services more usually associated with hospitals, such as diagnostic > testing, minor surgery, blood tests and X-rays. These could be run by > large private companies or consortia of GP’s. > What this means for staff - staff transferred to a GP practice as practice > staff will continue to have access to the NHS pension scheme, but may not > necessarily have access to the NHS Injury Benefit Scheme nor to early > retirement on grounds of redundancy. TUPE transfer will protect existing > NHS terms and conditions, but staff will not be covered by the NHS > negotiating machinery and as such all future changes to NHS terms and > conditions and pay are not automatic. > If the polyclinic or health centre is run by a private company then it is > likely staff will not have access to the NHS pension scheme. > Community foundation trusts > Community foundation trusts would provide those community services > currently run by PCTs. It is likely that a community foundation trust will > be established through a consortium of PCTs. Applications to establish a > community foundation trust will need to be approved by the SHA. > What this means for staff - transferred staff will retain NHS terms and > conditions (subject to the additional flexibilities that apply to all > foundation trusts) and retain full membership of the NHS pension scheme. > New starters will be appointed on NHS terms and conditions and will be > entitled to join the NHS pension scheme. (It is known that Foundation > Trusts have light touch regulation, so this option could give local > communities limited influence) > NHS integration > Vertical integration●● > This is where PCT provider-arm function is integrated with a local acute > service. It may involve the outright merger of an acute trust with a PCT > provider arm or a looser alliance of primary and community services > through multi-disciplinary team working and joint management. > What this means for staff - transferred staff will retain NHS terms and > conditions and retain full membership of the NHS pension scheme. New > starters will be appointed on NHS terms and conditions and will be > entitled to join the NHS pension scheme. > Horizontal integration●● > This is where more than one PCT provider-arm function is integrated and > may involve merger with one or a number of PCT provider arms. This may be > a first step towards creating a community foundation trust. > What this means for staff - transferred staff will retain NHS terms and > conditions and retain full membership of the NHS pension scheme. New > starters will be appointed on NHS terms and conditions and will be > entitled to join the NHS pension scheme. > Integrated Care Services > This is where joint health and social care services are established. This > may be through joint management arrangements between health and social > care functions or formally through integrated care organisations or the > creation of a “care trust” model. > What this means for staff - transferred staff will retain NHS terms and > conditions and retain full membership of the NHS pension scheme. New > starters will be offered either NHS or local authority terms and > conditions and may be entitled to join either the NHS or Local Government > pension scheme (dependent on individual circumstances) > Private sector or non NHS/independent sector > This would be as a result of the PCT deciding to transfer individual > services, or bundles of services to a private company (or to a community > or voluntary sector provider) through the process of tendering and > contracting. Unions have real concerns about this privatisation model as > experience to date shows that staff job security, guaranteed pay terms and > conditions improvements, trade union recognition and their NHS pension can > all be lost as a result of transferring out of the NHS. It also means that > services can become fragmented, particularly if a series of different > organisations run individual services. > > Transforming Community Services > http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publication > sPolicyAndGuidance/DH_093197 > Next Stage Review > http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publication > sPolicyAndGuidance/DH_085825 > NHS Constitution > http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publication > sPolicyAndGuidance/DH_085814 > Social Enterprise - Making a Difference: a guide to the Right to Request > http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publication > sPolicyAndGuidance/DH_090460 > Transfer of Undertakings (Protection of Employment) Regulations > http://www.berr.gov.uk/files/file20761.pdf > Cabinet Office Code of Practice > http://archive.cabinetoffice.gov.uk/opsr/workforce_reform/code_of_practice > /index.asp > > ****************************************************** Please note that if you press the 'Reply' button your message will go only to the sender of this message. 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