I am in the somewhat unknown position of having my contract and that of my whole service transferred to another NHS trust. I thought I might write a blog to document how that pans out, in case it was of interest to other people.

So, how did this happen?

I work for a CAMHS service which covers the southern half of a county, and I am employed by a hospital trust. A ‘competitior’ CAMHS covers the northern half of the county, employed by a mental health trust. The whole county has a single social services and education service, and there was some frustration that the service people could access from CAMHS was different depending on which side of the county they lived. I suspect each CAMHS would claim their service was superior, but for different reasons.

Its hard to compare another service to the one you work in, but it is my impression that in the north of the county, CAMHS is managed by managers and medics, has a tight remit for mental health and is one unified resource. In the south, CAMHS is managed mostly by the lead clinicians from each profession, has a looser remit that accepts a wider range of presenting problems, and has developed a lot of specialist service areas (eg a DBT team, a LAC team, a high dependency team, school and community-based primary mental health team, etc).

I don’t know how it feels in other service areas, but as part of the LAC team I know that no equivalent dedicated resource exists in the north patch, despite funding for LAC being split equally between the two services. As such, we’ve had to extend some of our training/consultation to make it county-wide, and we often get requests to see kids in their area who wouldn’t otherwise get a service. We’ve also had a lot of positive feedback from professionals and service-users that our service is valued, and many requests for a similar service to cover the other half of the patch.

So, commissioners decided in their wisdom, that the way to resolve this was to put the contract for supplying CAMHS to the whole county out to public tender. They designed a basic specification for the service and then asked for a 50 page document (plus appendices) from any interested parties explaining how they would deliver the service. As I understand it, the two existing CAMHS both entered a bid, as did another local NHS trust and a private provider. Each bid took hundreds of hours from clinicians and managers to prepare. They then went and presented their plans to a panel of commissioners who then picked a winner. The criteria for judging the bids have never been clear to me, but seem to have included wider business issues (such as financial contributions to an inpatient unit and land to build it on), rather than only the quality of the service being delivered and the future plans for CAMHS.

In this case the winner was the other CAMHS in the county, and it means that they will be given all the CAMHS funding and expected to provide the whole service from 1st October. All contracts of staff in our CAMHS will be transfered over to them on this date. No details have yet been provided about the service planned, and we haven’t been allowed to read the winning bid document.

We’ve been told that there will be no immediate change to services and no redundancies, though there was a comment about hoping for some natural attrition (which makes me worry that the current vacancies, including the post I have just left, might not be re-advertised). However, although the words are somewhat reassuring, the same mental health trust made 12 CPs redundant in its reconfiguration of adult services 18 months ago, and tends to view us as overpriced compared to other mental health professions. Currently we have 3 times as many CPs in our patch, and a much wider spread of bandings, and a culture of being able to play to our strengths. The feeling is that this makes us an obvious target for cuts. Unsurprisingly morale is at an all time low.

So, I’m a bit anxious to find out how the dust is going to settle. Its likely that in a year from now I’ll be in a different office (as I currently have a room in the hospital) and that will take me away from many friends who are colleagues outside of CAMHS that I currently see quite a lot of. However what is really important to me is how much the job remit and team I work with from day to day will change, and that remains the big unknown. The reason I’ve stayed in this service for 5 1/2 years is because I like my colleagues and supervisor, and because I like having some autonomy in the way I prioritise the demands on my time. If that changes, then I’ll be increasingly looking to explore other options (such as starting a family, or expanding my private practise, or moving elsewhere in the country). In the meanwhile, living with such uncertainty is rather discomforting.

It seems typical of the way the NHS is headed, competitive commissioning and increasingly business-like. I’m reassured by discovering I’m not the only that doesn’t like it. The NHS was supposed to be about being part of a national non-profit-making public sector organisation that gave you career stability, which was why I accepted lower pay than in the private sector. I feel like if I was going to work in a market economy then I’d go entirely private and have full autonomy. This policy of asking NHS trusts to act like businesses sits somewhere in between, without offering me the advantages of either option.

In a lot of ways I get more positive strokes for my private work – more pay, more feedback, more respect given to my opinions and of course you get free choice of what you choose to do (or not do) and how you arrange it. However, you don’t get the same sense of being part of a team, you have to negotiate your own supervision, and you don’t get the protection of sick pay, maternity, pension, and PAYE (tax has to be calculated by an accountant, and paid in two painful large lump sums).

It makes me wonder if the way forward is making private agencies of CPs that contract to deliver services into the NHS, without the weight/expense of NHS trusts above them, or whether in fact this is an uncomfortable middle ground that lacks the advantages of either NHS employment or private-sole-practitioner autonomy. I guess I’ll soon find out!