In January 2009 the Department of Health published Transforming Community Services – Enabling new patterns of provision.  It sets out the importance of quality health and community care provision and what is required to modernise services and enable transformational change within the NHS. 

Transforming Community Services builds on the Lord Darzi NHS Next Stage Review: Our vision for primary and community care July 2008 which set out a commitment to support the NHS to make local decisions on both organisational and governance models to deliver flexible, responsive, and high quality services. 

Key to transformation in the NHS is the separation of the internal operational provider services from the commissioning function.  Therefore internal providers delivering a service will need to be subject to the same business and financial rules as other external providers.  This is set out in the NHS Operating Framework for 2008/09.  All PCT direct provider organisations should therefore have a contractual relationship with the PCT commissioning arm by April 2009.  This arrangement is to be contracted through the national contract for community services in 2009/10.

By October 2009 PCT commissioners with practice based commissioners should have developed a detailed plan setting out how they intend to transform community services ready for SHA agreement.

Likewise by October 2009 PCT Providers should consider appropriate models and governance arrangements as to how services will be shaped and delivered.  Providers will now have the opportunity to declare an interest in social enterprise models or Community Foundation Trusts.  These models enable providers through a ‘right to request’ to enter into integration with other NHS organisations, integrated care organisations or non-NHS bodies.  These decisions have had to come out of robust and sustained consultation with local staff and the trade unions.

PCT's are at different stages of change and serve different populations but the following principles should outline coherent and managed transformational change:

·    Patients and carers interests at the heart of services.
·    Quality services which are safe, effective and personalised.
·    Importance of a PCT clear commissioning strategy.
·    Services to provide value for money.
·    High level of local engagement and robust consultation in decisions about services.
·    Different solutions and services will be required and reflect local need and characteristics.
·    Early and on-going engagement with staff, trade unions and stakeholders in the decision making process.
·    Quality human resource management to support service and organisational changes.
·    Assurance, approval and authorisation processes to be clear and transparent across all stakeholders.
·    Importance of integrated services upholding the principles set out in world class commissioning and patient choice.
·    Change proposals to be in line with Principles and Rules for Cooperation and Competition (Annex D of the 2008/9 NHS Operating Framework).  This document should also be read alongside the Framework for Managing Choice, Cooperation and Competition May 2008 and Primary Care Trust Procurement Guide for Health Services May 2008
·    Services are required to have been equality impact assessed.
·    Safeguards thought through and demonstrated to protect continuity of service, assets, and staff pensions.

Overall this guidance sets out the rationale and the principles which should govern transformational change. It also considers the various organisational and service models available such as direct provision, Community Foundation Trusts, Social Enterprises such as Community Limited by Guarantee, Industrial and Provident Community Benefit Societies, Community Interest Companies and Charitable Incorporated Organisations.  It also sets a detailed timetable for both PCT commissioners and providers in terms of transformational objectives.

For further information visit: Transforming Community Services – Enabling new patterns of provision 2009