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