New Forms of Governance for the NHS? Peter Hunt Mutuo 19 th 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 dont 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 Governance Actively 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 Monitors 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 GPs Health Professionals Public/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