‘Out of Hours 2005?’ a whole system review of the future scope and

organization of OoH Services

Laurie McMahon Office for Public Management

The need for evolution…

• problems with staffing existing co-ops

• managerial capacity of existing arrangements

• pressure for inclusion in audit, review and scrutiny • pressure to move to a multi disciplinary OoH service

• the movement to a 24/7 ‘unscheduled care’ service

• GPs reaction to the new contract

the project partners.…

• National Association of GP Cooperatives

• Primary Care ‘OoH’ Team, Department of Health

• Office for Public Management

• people like you!

the purpose.…

• develop ‘plausible’ organizational models

• establish criteria by which to judge them

• ‘whole system’ commentary on benefits/risks

the three phases.…

a 'core group' design meeting a ‘whole system’ evaluation event a 'white board’ session to distil the learning

the criteria.… Delivers care where appropriate or moves the patient through to service required Provides sufficient access to increasing numbers of people Able to deliver ‘beyond December 2004’ Has effective clinical governance practice and quality assurance structures Has accountability to its local population Integrates well with wider emergency services Demonstrates high levels of co-ordination between organizations and professionals Delivers quality outcomes and provides value for money Has IM&T and processes that integrate with the wider NHS Is equitable across the whole population

the criteria.…dDriven by local patient need, not expenditure or costs Able to develop in a sustainable way Accurate estimation of future demand and weekly / annual fluctuations possible Capacity to ‘manage’ demand Develops its people and provides strong clinical leadership Cost effective rather than lowest cost In line with ‘choice & plurality’ Limited real or perceived ‘conflicts of interest’ Coherent corporate governance arrangements Delivers Government policy Political acceptability

the main themes…

accountability governance local sensitivity potential to grow integration

the organizational models

    GP Equity Model        Private Company Model        ‘PCT–as-Provider’ Model Public Interest Company Model

the organizational models

    GP Equity Model        Private Company Model        ‘PCT–as-Provider’ Mode Public Interest Company Model Acute Trust Provider Model

the organizational models

    GP Equity Model        Private Company Model        ‘PCT–as-Provider’ Model ‘Public Interest Company’ Model

the public interest organization Aan organisation for specific public benefitA a public benefit organisation - over timeA a trading organisation A a cost efficient organisationAan entrepreneurial organisationA a secure not-for-profit organisationAan organisation that can raise capital independentlyAan organisation independent of direct political controlAan accountable organization

Some PIO differences….

• a mutual company

• a public interest company

• a community interest company

A question…..….

Is a PIO part of the NHS ‘family’?

the organizational models

    GP Equity Model        Private Company Model        ‘PCT–as-Provider’ Model Public Interest Company Model

The OoH Abacus

_ +

there are always ‘downsides’………

_+

…. it didn’t work so neatly!

the GP equity model Plus sides  detailed knowledge of locality/ needs strong mutual spirit attractive to staff local clinicians centralD

the GP equity modelD DOWNS       ability to raise finance risk - long term contracts to attract GP equity members sufficient strength in management? patients and the profit motive? terms and conditions for staff ownership/equity problems

the private company model

UPS  easy access to start up and development capital form well understood be the commercial sector lots of initial energy ‘going with the flow’ of ‘plurality’ existing models that ‘work’ safe option organizationallyD

the private company model

DDOWNS       negative public and professional perceptions viability if low profit? commitment to public service? commitment to local accountability? problematic conditions of employment ‘mergers and acquisitions’ and local interests

the PCT provider modelUPS safest, easiest move no profit motive additional costs of ‘set up’ avoided (?) risk and clinical governance frameworks in place responsive to ‘Agenda for Change’ NHS ‘Terms and Conditions

the PCT provider model

UDOWNS       PCT’s capacity to deliver – overload! entrepreneurial management ? where’s the ‘choice and plurality’? conflicts of interest – commissioner and provider freedom from central regulation and political interference?

the GP/PIC modelUPS credibility with local people ‘not-for-profit’ status attractive to staff – more ‘mutual’ free of political control and performance management highly flexible and responsive able to grow and merge with other PICs transparent financial arrangements accountability to local people part of the NHS family?

the GP/PIC modelUDDOWNS

       PIC status does not exist commercial sector does not ‘understand’ ability to raise capital?

the winner…..?

principle of mutuality public perceptions of ‘profiteering’ independence of ‘the state as provider’ potential to grow local sensitivity and accountability

In discussion…..….

• PCT provider as temporary ‘safe default’ – a ‘holding’ strategy

• plan to migrate

2004

2006+

GP’s ‘multi service’

‘OoH’

‘24/7’The Migration…..

In discussion…..….

• PCT provider as temporary ‘safe default’ – a ‘holding’ strategy?

• plan to migrate to the ‘south east corner’

• replication of existing service ‘a missed opportunity’

• replacing existing service just not affordable

• we will not be able to ‘buy’ as many GPs

• PCTs need to ‘round table’ now…

• ‘Out of Hours’ – the perception of professional/institutional interests

• need for real ‘mapping’ of NHS services ‘round the clock’

• creating greater access for patients and a more contented public!

‘Out of Hours 2005?’ a whole system review of the future scope and

organization of OoH Services

Laurie McMahon Office for Public Management