Langbaurgh Social Langbaurgh Social Enterprise – A Case StudyEnterprise – A Case Study

Ian ReeveIan Reeve

Managing DirectorManaging Director

A Bit About Langbaurgh Social A Bit About Langbaurgh Social EnterpriseEnterprise

• Serves a population of 97,000 in Redcar, Serves a population of 97,000 in Redcar, East Cleveland and GuisboroughEast Cleveland and Guisborough

• A history of working between practicesA history of working between practices

• Made up of and governed by a Made up of and governed by a Stakeholder Board made up of 15 Stakeholder Board made up of 15 General Practices with 2 patient repsGeneral Practices with 2 patient reps

• Four Directors – appointed by a Four Directors – appointed by a Stakeholder BoardStakeholder Board

What is Langbaurgh Social What is Langbaurgh Social Enterprise?Enterprise?

• Company Limited by Guarantee from Oct Company Limited by Guarantee from Oct 20072007

• Directors, Memorandum of Agreement and Directors, Memorandum of Agreement and Articles of associationArticles of association

• Legal entity - can own assets, borrow, Legal entity - can own assets, borrow, employ staff and is subject to companies employ staff and is subject to companies regulation, tax regime and can form joint regulation, tax regime and can form joint ventures with other entitiesventures with other entities

The Three Core Elements of a The Three Core Elements of a Social EnterpriseSocial Enterprise

• Community Membership - a Community Membership - a membership of 15 general practicesmembership of 15 general practices

• For Benefit of the Community - For Benefit of the Community - purpose is to improve the health of purpose is to improve the health of the local population, particularly the local population, particularly through primary care servicesthrough primary care services

• For profit, but all profits are re-For profit, but all profits are re-invested in the purpose of the invested in the purpose of the enterpriseenterprise

How is LSE StructuredHow is LSE StructuredStakeholder Board14 practices, 2 patients,

1 practice manager

Patient Group

DirectorsFour Directors drawn

from practices

Meets to approve direction, agree plans, authorise services, appoints directors

Members drawn from practice patient groupsto advise on changes in patient pathways

Meet as and when – advise on strategic direction, what we do, how we do it and how its going

ExecutiveClinical Director, Managing Director, Pharmacist,

practice managers, GP clinical leads, nurses

The workers, Clinical Director two sessions, Managing Director 4 days, rest project based

What We Set Up To DoWhat We Set Up To Do

• Help local primary care services and Help local primary care services and general practice thrivegeneral practice thrive

• Make Practice Based Commissioning Make Practice Based Commissioning a Successa Success

• Directly deliver local servicesDirectly deliver local services

Services We DeliverServices We Deliver• Easy winner – joint procurementEasy winner – joint procurement

• Locum bank – Admin, reception, nurse, GPLocum bank – Admin, reception, nurse, GP

• Service provision – Resolution Health CentreService provision – Resolution Health Centre

• Minor SurgeryMinor Surgery

• Support clinical commissioning and Support clinical commissioning and development of Langbaurgh NHS Clinical development of Langbaurgh NHS Clinical Commissioning GroupCommissioning Group

We became self sufficient within a yearWe became self sufficient within a year

Oh no we haven’t!!Oh no we haven’t!!

Why Form a Social Why Form a Social Enterprise?Enterprise?• The environmentThe environment

– The big things – changing face of general The big things – changing face of general practice, ie PMS review, darzi, competition, big practice, ie PMS review, darzi, competition, big players will get bigger, takeovers lead to players will get bigger, takeovers lead to powerful providers, impact of the recession powerful providers, impact of the recession (more demand, less resource)(more demand, less resource)

– The little things - what’s happened to The little things - what’s happened to community services and what is happening community services and what is happening now, increasing demands on practices, now, increasing demands on practices, common complaintscommon complaints

• Taking control….not just be responsive or Taking control….not just be responsive or simply let things happensimply let things happen

• Having a single voice and resource to Having a single voice and resource to support all practicessupport all practices

• Taking advantage of the massive Taking advantage of the massive opportunities in working togetheropportunities in working together

Establishing a Separate Establishing a Separate EntityEntityCreating a separate entity means:Creating a separate entity means:

– Security and strength in numbers, act in Security and strength in numbers, act in unisonunison

– Empowerment for a common purpose, Empowerment for a common purpose, – Take financial risk without directly impacting Take financial risk without directly impacting

on practice partnershipon practice partnership– Hold contracts, deliver services, make profitsHold contracts, deliver services, make profits– Partnership between practices whilst Partnership between practices whilst

maintaining independence of individual maintaining independence of individual practicespractices

– Ability to form partnerships with other bodiesAbility to form partnerships with other bodies(All this could be achieved through a number of (All this could be achieved through a number of

legal forms)legal forms)

So Why a Social Enterprise?So Why a Social Enterprise?• Its simple yet powerful concept:Its simple yet powerful concept:

– Made up of its StakeholdersMade up of its Stakeholders– For the benefit of the communityFor the benefit of the community– Not for Profit…….For profit but profits invested for the Not for Profit…….For profit but profits invested for the

benefit of the communitybenefit of the community

A set of rules that all 15 Practices could acceptA set of rules that all 15 Practices could accept

Only form that created trust between all partiesOnly form that created trust between all parties

Supported by Gov’t and all Political PartiesSupported by Gov’t and all Political Parties

Access to grantsAccess to grants

Why Social Enterprise?Why Social Enterprise?

• Acceptable – patients, practices, staff, Acceptable – patients, practices, staff, Government, all political parties, Government, all political parties, Department of Health, PCTDepartment of Health, PCT

• High profile – Access national and local High profile – Access national and local funding creating a foundation on which to funding creating a foundation on which to build successbuild success

• Stay in control. Practices contribute to the Stay in control. Practices contribute to the extent that they wish (a for profit company extent that they wish (a for profit company is bound to expect that practices earn is bound to expect that practices earn their share of profits)their share of profits)

• Patient benefit prime purpose Patient benefit prime purpose

What a Social Enterprise Isn’tWhat a Social Enterprise Isn’t

• An easy way out of changeAn easy way out of change

• A CommissionerA Commissioner

• Not for profitNot for profit

• The Private Sector (thin edge of the The Private Sector (thin edge of the wedge)wedge)

• A way of avoiding taxA way of avoiding tax

Success in Setting Up As A Success in Setting Up As A Social Enterprise (1)Social Enterprise (1)

• Ensuring it is for the benefit of all, not just Ensuring it is for the benefit of all, not just a few (not jobs for the boys….or girls)a few (not jobs for the boys….or girls)

• Selfless leadership and face to face Selfless leadership and face to face contact with all potential memberscontact with all potential members

• Must reflect the values, beliefs and ethics Must reflect the values, beliefs and ethics of membersof members

• Communication…communication…etcCommunication…communication…etc• Dedicated quality supportDedicated quality support• Getting finance and legal structure rightGetting finance and legal structure right

Success As A Social EnterpriseSuccess As A Social Enterprise

• Minimal bureaucracyMinimal bureaucracy

• Business - customer comes first (PCT and Business - customer comes first (PCT and Patients) – understand what your customer Patients) – understand what your customer wantswants

• Establish your norms and ways of workingEstablish your norms and ways of working

• Make a profit with everything you doMake a profit with everything you do

• Choose partnerships that complement Choose partnerships that complement your strengthyour strength