FIPO Conference on DTC’S October 2003…

FIPO (Federation of Independent Practitioner Organisations) held a major conference on Diagnostic Treatment Centres (DTCs) at the Royal College of Obstetricians and Gynaecologists on 7th October 2003. This conference was generously sponsored by HCA International Ltd, the Wellington Hospital and Standard Life Healthcare.

The term “DTC” is to be replaced by “TC” or “ISTC” (Independent Sector Treatment Centres) as it seems likely that Diagnostics will be excluded from the portfolio of services to be offered in these new centres. Whilst the majority of TCs will be NHS extensions (essentially ring-fenced surgical beds) there will be new privately run centres, which will contract for NHS and possibly self-pay and private work. The first of these ISTCs (22 centres and 2 mobile units) will provide surgical services around the country. The final contractual details for these centres are currently being negotiated but it seems clear that the preferred bidders come from seven overseas companies and new entrants to the market. None of the UK Independent Hospital Groups were successful in their bids.

The overall target for these Treatment Centres is about 250,000 operations made up of 135,000 extra procedures and 115,000 already on NHS waiting lists. Approximately two-thirds of this work will be undertaken in the first waves of ISTCs. A second wave of successful bidders for centres will be appointed in due course.

Speakers at the FIPO conference came from all sides of the healthcare industry and the medical profession. There were questions raised about the functioning of the ISTCs in terms of staffing, clinical governance and training of junior doctors. Concerns were also raised about the fact that NHS Trusts might be destabilised by losing funding and that the complexity of the NHS workload would increase as simple cases (cherry picked?) were removed.

The funding of the ISTCs was unclear and PCTs were uncertain about how they would purchase from the new centres as the final costs had not yet been clarified. The eventual introduction of fixed tariffs by the Department of Health (HRGs – healthcare resource groups) may clarify the situation.

Some NHS TCs were working efficiently and the Conference heard of an example in London where pooled waiting lists in a region coupled with pressure on consultants and local managers (coupled with a modest fee for service system) was needed to achieve results. Generally, however, the rate and type of day care surgery currently performed in the NHS shows wide variation between Trusts and there was a need for some “drive” or initiative to reduce waiting lists.

The reasons why UK Independent Hospital Sector had been completely unsuccessful in their bids for ISTCs were uncertain although it seems likely that the individual case reimbursements on offer were unsustainable for UK providers (but seemingly acceptable to the new successful companies). The conference heard that the UK Independent sector could quite possibly take up the NHS waiting list slack via the Concordat. It was stated that there could now be overcapacity developing and that this would lead to a Third Market which will affect the UK independent hospital providers and consultants.

Private medical insurers would be looking at different types of insurance policies to adjust to the new market and the response of the profession would have to be realistic with the formation of Chambers being seen as one way in which groups of consultants could reorganise and contract with ISTCs.

Within the audience there were several representatives from the preferred bidders for ISTCs and they expressed a positive interest in continuing a dialogue with the medical profession. The question of NHS staff or consultants working in the new ISTCs may be relaxed. They were also reassuring about the quality of foreign staff and were open to the prospect of training within the new ISTCs.

In conclusion, there are clearly many unanswered questions about ISTCs and the situation may become clearer in the next few months. Whether these new centres can get up and running and achieve the government targets by 2004-2005 remains to be seen.

For further information and detailed articles please follow the link below:


Original Programme

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