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New Forms of Governance for the NHS?
Peter HuntMutuo
19th January 2006
Change in Primary Care
• Develop health improvement
• Manage long term conditions better
• Link primary care with social care
• Move much of diagnostics/outpatients from secondary care
• Provide most minor surgery
Primary Care Provision Now
• GP Practices– 9,000 practices– Usually partnerships– 30,000 GPs 3,500 single-handers
• Some PCTs– With salaried doctors– Where GP practices don’t cover
• PCT role to commission services
PCT Features
• Quangos• Staff have NHS Culture• Some are good providers• Most are not• Responsible for commissioning
– What to commission– How much– From whom
GP Practice Features
• Partnerships less attractive– 40% of those qualified become principals– Limited career pathways– Difficult to introduce innovation
• Ageing GP population– Acute problem in London– But a growing problem elsewhere
• Deprived areas worse off
Primary Care Stakeholders
• The public (patients, taxpayers)• The GPs
– Owners of the providers– They are the key providers
• Other Health professionals– Community nurses– Health visitors etc.
• The PCTs– Commissioners– Employers
• The rest of the NHS – DH/SHA/Government
What The Public Want
• Services that are:– Easily accessible– Quick and efficient– Trustworthy– Consistent– Make them better/avoid illness
From GovernanceActively involved in:• Membership development• Public relations + perceptions• Develop a Governor job
description• Develop the mutual expectations
of the Board/ COG• Assisting formal consultations • Overview of effectiveness• Communications with public and
working with media• Governor networking• Consultation with board
Want more information on:• Understand trust strategy• Patient education – member
information by clinician / health promotion
• An understanding of staff issues• Monitor’s view• Trust/Hospital performance
reports• Financial reports to an agreed
level of detail• Briefings from health professionals• Budget for membership• Co-ordination of contact with
patients / CPPHH / forum• NHS information
Primary Care Changes
• PCTs to stop providing
• Need for better configured businesses to achieve change
• New entrants to provision will bring contestability
• Opportunities for existing providers and allied staff
New Providers
• New corporate entities
• Still independent of state
• Bigger and more capacity
• Able to achieve changes outlined
• Could be either conversions, new independent entrants or new mutual businesses
Mutual Providers
Board
Stakeholder Council
GPsHealth
ProfessionalsPublic/users
Why Be Mutual?
• You get choices– Consumer or professionally driven– Or a mix
• It is corporately robust– Strong corporate governance– Empowers the right people to the right level
• Maintains the NHS ethos– An extension/modern interpretation of the NHS – It is less threatening – value is re-circulated
• It is accountable– Membership drives accountability - demonstrably
The PCT
• Commissioner– Not just the contract letter– Make contractors accountable to their users– Design patient pathways
• Not provider but enabler
What Should Be Done?
• Government should state its preference clearly for a diverse sector of providers
• It should understand the importance of smart commissioning as the key to financial accountability
• It should identify how to encourage the growth of new providers – not wait for it to happen because it will not
• It should facilitate business support to NHS professionals who wish to establish new mutual providers
The Result
• Diagnostics & minor surgery closer to home
• GPs get tools to tackle health inequalities
• Management services and corporate competence assured
• The users are built into the service providers