Making Healthcare Mutual A Mutual Provider for OOH Primary Care Cliff Mills 4 th March 2004

This presentation 1.Introduction – a mutual structure for OOH primary care 2.Basic stages in establishing a new mutual provider 3.Issues concerning directors liability

1. Introduction – a mutual structure for OOH Primary Care

Why are we talking about mutuality? “Making Healthcare Mutual” (Dec 02) “NHS Foundation Trusts … independent … organisations, modelled on co-operative societies and mutual organisations” “Care on Call” (Jan 04)

Mutuality – the background Traditional mutuality –Mutual insurers –Friendly societies –Building societies –Co-operative societies Self-help movement Owned and controlled by local people

Characteristics of traditional mutuality Customers (community) are the owners No investor owners No distribution of profits Commitment to social (community) purpose Democratic or representative governance (local accountability)

Mutuality and the NHS Mutual societies were the fore-runners to the welfare state Need for a national health service led to state-ownership and control Centralised state-ownership no longer considered efficient Public/private mentality

Explanation of Cobbetts involvement Legal advisors to the retail co-operative movement Involved in modernisation of mutual law Promoters of mutuality and community ownership in public services –Leisure –Social housing –Children’s services –Education

The Public Services choices State ownership Private (investor) ownership Mutual (community) ownership What is the owner’s priority? How do you drive efficiency and success?

What is “ownership”? Not the ability to sell and realise value The power to make the organisation do what you want –Power to influence service and how it is delivered –Power to sack those who fail to deliver “Accountability” Ability to drive efficiency and success

Modern mutual comprises … Members (Customers, local community, staff) Strategic Board (Elected representatives of members, partnering organisations) Professional Executive

Modern mutuality Retains –Customer/community ownership –No investor owners/no profit distribution –Commitment to social purpose –Democratic representative governance Adds –Strategic board as forum for partnership between key parties

Examples of modern mutuality NHS Foundation Trusts Leisure Trusts Football Trusts New models in social housing Children’s centres and Sure Start

A model for OOH primary care Members, comprising –GPs –other employees –patients and public Strategic, board comprising –Elected representatives of GPs, employees, patients and public –PCTs –Acute Trusts, ambulance service etc Professional executive

A model for OOH primary care (continued) Role of professional executive –to run the organisation Role of strategic board –to help to shape and to approve strategy, and to hire and fire executives Role of members –to elect their representatives, and hold them to account

Role of strategic board To be a forum for participating organisations to work together To provide a voice for customers (patients) providers of service (GPs and employees), the paying party (PCTs) others involved in and around health care

2. Basic stages in establishing a new mutual provider

Stage 1 - new OOH Contract Commissioning/Procurement process Implementing the nGMS Contract: Out- of-Hours (DH October 2003) PCT’s own procurement policies Knowledge of provision market Value Probity

New OOH Contract Parties –PCT/PCTs (1) –Newco (2) Individual, joint or lead procurement Services to be provided Time Period Variation/Development

Stage 2 - Incorporation Engage relevant parties Adapt model rules Seek registration/incorporation Appoint first strategic board Appoint chief executive

Stage 3 - getting started Transfer of current GP Co-ops New arrangements

Transfer of current GP Co-ops Premises Employees Assets

Transfer process – preliminary steps Obtain consents –Premises –Leases (eg cars, computers) Consultation –Employees –User groups/commercial clients Notification (eg rates)

Transfer process – formal approvals Board of transferor(s) (Possibly) members of transferor(s) Executives and strategic board of new provider

New arrangements Bank account VAT registration (?) PAYE Accreditation Professional resources Insurances

Priority … continuity of cover Managing the transition –Retaining current knowledge –Utilising existing resources –Avoid wastage Retaining GP and employee support Establishing new partnerships Maintaining public confidence

3. Issues concerning directors liability

Directors liability – the current position GPs have legal responsibility to provide cover By consent GP co-ops meet that responsibility for GPs If a shift will be under-resourced, co-op can ask for additional GP support Ultimate protection for co-op directors – hand back responsibility to GP practices

Directors liability – new position PCTs have legal responsibility to provide OOH cover Can seek by contract to pass on responsibility to a provider But retain residual responsibility PCTs need to consider their own contingency plans and insurance

Directors of new provider No legal responsibility until new provider takes on a contract What responsibility in the contract? –Specified number of GPs per shift –Adequate cover What should new provider accept in a contract?

What risks should new provider accept in a contract? Fundamental factors –Availability of GP cover (risk for provider) –Cost (risk for PCT or provider depending on contract) Mitigating factors –Utilising other support (option for PCT or provider) –Insurance (by PCT or provider) –Risk management (to minimise premiums)

Finding a solution Acceptable level of risk for both parties Ability to manage the risk Appropriate back-up (including insurance) costed and built into business plan Agreeing the new OOH contract

Making Healthcare Mutual A Mutual Provider for OOH Primary Care Cliff Mills 4 th March 2004