‘Out of Hours 2005?’ a whole system review of the future scope and organization of OoH Services

1. ‘Out of Hours 2005?’ a whole system review of the future scope and organization of OoH Services Laurie McMahon Office for Public Management

2. The need for evolution… • problems with staffing existing co-ops • managerial capacity of existing arrangements • pressure for inclusion in audit, review and scrutiny • pressure to move to a multi disciplinary OoH service • the movement to a 24/7 ‘unscheduled care’ service • GPs reaction to the new contract

3. the project partners.… • National Association of GP Cooperatives • Primary Care ‘OoH’ Team, Department of Health • Office for Public Management • people like you!

4. the purpose.… • develop ‘plausible’ organizational models • establish criteria by which to judge them • ‘whole system’ commentary on benefits/risks

5. the three phases.… a 'core group' design meeting a ‘whole system’ evaluation event a 'white board’ session to distil the learning

6. the criteria.… Delivers care where appropriate or moves the patient through to service required Provides sufficient access to increasing numbers of people Able to deliver ‘beyond December 2004’ Has effective clinical governance practice and quality assurance structures Has accountability to its local population Integrates well with wider emergency services Demonstrates high levels of co-ordination between organizations and professionals Delivers quality outcomes and provides value for money Has IM&T and processes that integrate with the wider NHS Is equitable across the whole population

7. the criteria.… dDriven by local patient need, not expenditure or costs Able to develop in a sustainable way Accurate estimation of future demand and weekly / annual fluctuations possible Capacity to ‘manage’ demand Develops its people and provides strong clinical leadership Cost effective rather than lowest cost In line with ‘choice & plurality’ Limited real or perceived ‘conflicts of interest’ Coherent corporate governance arrangements Delivers Government policy Political acceptability

8. the main themes… accountability governance local sensitivity potential to grow integration

9. the organizational models GP Equity Model Private Company Model ‘PCT–as-Provider’ Model Public Interest Company Model

10. the organizational models GP Equity Model Private Company Model ‘PCT–as-Provider’ Mode Public Interest Company Model Acute Trust Provider Model

11. the organizational models GP Equity Model Private Company Model ‘PCT–as-Provider’ Model ‘Public Interest Company’ Model

12. the public interest organization Aan organisation for specific public benefit A a public benefit organisation - over time A a trading organisation A a cost efficient organisation Aan entrepreneurial organisation A a secure not-for-profit organisation Aan organisation that can raise capital independently Aan organisation independent of direct political control Aan accountable organization

13. Some PIO differences…. • a mutual company • a public interest company • a community interest company

14. A question…..…. Is a PIO part of the NHS ‘family’?

15. the organizational models GP Equity Model Private Company Model ‘PCT–as-Provider’ Model Public Interest Company Model

16. _ + The OoH Abacus

17. _ + there are always ‘downsides’………

18. …. it didn’t work so neatly!

19. the GP equity model Plus sides detailed knowledge of locality/ needs strong mutual spirit attractive to staff local clinicians central D

20. the GP equity model D DOWNS ability to raise finance risk - long term contracts to attract GP equity members sufficient strength in management? patients and the profit motive? terms and conditions for staff ownership/equity problems

21. the private company model UPS easy access to start up and development capital form well understood be the commercial sector lots of initial energy ‘going with the flow’ of ‘plurality’ existing models that ‘work’ safe option organizationally D

22. the private company model DDOWNS        negative public and professional perceptions viability if low profit? commitment to public service? commitment to local accountability? problematic conditions of employment ‘mergers and acquisitions’ and local interests

23. the PCT provider model UPS safest, easiest move no profit motive additional costs of ‘set up’ avoided (?) risk and clinical governance frameworks in place responsive to ‘Agenda for Change’ NHS ‘Terms and Conditions

24. the PCT provider model UDOWNS        PCT’s capacity to deliver – overload! entrepreneurial management ? where’s the ‘choice and plurality’? conflicts of interest – commissioner and provider freedom from central regulation and political interference?

25. the GP/PIC model UPS credibility with local people ‘not-for-profit’ status attractive to staff – more ‘mutual’ free of political control and performance management highly flexible and responsive able to grow and merge with other PICs transparent financial arrangements accountability to local people part of the NHS family?

26. the GP/PIC model U DDOWNS        PIC status does not exist commercial sector does not ‘understand’ ability to raise capital?

27. the winner…..? principle of mutuality public perceptions of ‘profiteering’ independence of ‘the state as provider’ potential to grow local sensitivity and accountability

28. In discussion…..…. • PCT provider as temporary ‘safe default’ – a ‘holding’ strategy • plan to migrate

29. ‘OoH’ 2004 GP’s ‘multi service’ ‘24/7’ 2006+ The Migration…..

30. In discussion…..…. • PCT provider as temporary ‘safe default’ – a ‘holding’ strategy? • plan to migrate to the ‘south east corner’ • replication of existing service ‘a missed opportunity’ • replacing existing service just not affordable • we will not be able to ‘buy’ as many GPs • PCTs need to ‘round table’ now… • ‘Out of Hours’ – the perception of professional/institutional interests • need for real ‘mapping’ of NHS services ‘round the clock’ • creating greater access for patients and a more contented public!

31. ‘Out of Hours 2005?’ a whole system review of the future scope and organization of OoH Services Laurie McMahon Office for Public Management