making healthcare mutual a mutual provider for ooh primary care cliff mills 4 th march 2004...
TRANSCRIPT
Making Healthcare Mutual
A Mutual Provider for OOH Primary Care
Cliff Mills4th 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 Mills4th March 2004