Background In 2015 the local NHS Integrated Care Organisation put community services out to tender across two NHS Clinical Commissioning Groups (CCGs), a population of 235,000. This included specialist palliative care team (SPCT) for hospital and community and Consultants. The SPCT were an integral part of the local integrated service, the risks to patients and families of not having a seamless service would be detrimental. In 2016 two individual providers won the contract; one private and one NHS. Both approached us independently suggesting they subcontract SPCT to the hospice.

Aims Hospice to employ SPCT under terms of two separate subcontracts, one private, one NHS, ensuring patients and families receive seamless care wherever they are.

Methods Sub-contract required Board approval, considering risks and benefits to hospice reputation, including public perception of hospice ‘funding’ private healthcare. Learning curve for Directors in projecting five year costings with no knowledge of current costs, ensuring no financial risk to charity, and legalities around contracts.

Results Agreeing the specification and quality data was time consuming. Numerous bureaucratic executive layers through which to proceed for approval, and efforts to ensure that the service was fully funded for the duration of the subcontract to avoid risk to charity.

Conclusion A year later the SPCT fully integrated in hospice with no financial risk to charity as fully funded. Hospice corporate uniform supplied so visible immediately as hospice employee, all one team raises awareness for income generation. Ability to be creative with roles and working patterns ensuring seven day clinical and admin cover, and implementation of development roles within team.