New Forms of Governance for the NHS?

1. New Forms of Governance for the NHS? Peter Hunt Mutuo 19th January 2006

2. 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

3. 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

4. PCT Features • Quangos • Staff have NHS Culture • Some are good providers • Most are not • Responsible for commissioning • What to commission • How much • From whom

5. 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

6. 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

7. What The Public Want • Services that are: • Easily accessible • Quick and efficient • Trustworthy • Consistent • Make them better/avoid illness

8. 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 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 From Governance

9. 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

10. 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

11. Mutual Providers

12. 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

13. The PCT • Commissioner • Not just the contract letter • Make contractors accountable to their users • Design patient pathways • Not provider but enabler

14. 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

15. 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