Rushcliffe social enterprise: what, who, why and how

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Rushcliffe social enterprisewhat, who, why and
how?

• Dr Stephen Shortt
• GP East Leake
• (Formerly Chair, Professional Executive Committee
  Rushcliffe PCT)
• Project Sponsor Rushcliffe Social Enterprise
• stephen.shortt_at_gp-c84005.nhs.uk

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1. What?

• New corporate structure
• Not for profit Community Benefit Society
• Company Limited by Guarantee
• New service delivery model through
• Collaborative approach to PBC
• Community services
• Community engagement
• Individual practice contractual arrangements out
  of scope
• Powerful incentives to provide these services in
  a cost-effective manner simultaneously
  maintaining quality and minimize the risk of
  future disenrollment

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1. What ?

• Horizontal and vertical accountability
• Lay - clinical board (with lay majority)
• APMS contract with commissioning PCT
• Staff supply agreement for clinical and
  managerial staff
• Explicit (currently indicative) budget
• Freed up resources re-invested in services

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2. Who ?

• 17 General Practices
• PCT provider services (140 WTE staff)
• Community Matrons , District Nurses, Health
  Visitors, Occupational Therapists,
  Physiotherapists, Intermediate Care, Primary Care
  Mental Health Nurse Practitioners, Podiatrists,
  Health Care Assistants,
• 115,000 patients
• Local ownership and accountability

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3. Why?

• Size does matter
• Allocation of resources historically favoured the
  more costly technology based medical care
• Institutional capability for delivering primary
  care services has been weakened
• Separation between primary and secondary levels
  of care exacerbated
• Difficult for providers to assure that the right
  patient receives the right kind of care, in the
  right place and for the right reason
• Current community provider model not fit for
  purpose

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3. Why?
CPLNHS PCT form and function future of
provision Foundation environment Independent
Sector
OHOCOS Patient choice autonomy Extended range
of services New access opportunities Contestabilit
y Independent Sector
Organising framework for NHS reforms
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3. Why?

• Current care delivery model not evolved to meet
  changing demands
• Focussed on emergent and acute conditions
• New delivery system required whose design
  principles are sooner, earlier and nearer
• Acknowledges current pressures and future risk by
  need to manage (cut, cope and create) demand
• Manage elective and emergency demand
• Long Term Conditions
• Prescribing
• Provide hospital care in alternative setting
• Develop clinical networks and integrated care
  pathways
• Develop supporting infrastructure

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4. How?

• Attractive vision and clear narrative for
  clinicians
• Motivates clinicians to make best use of
  resources to maximise clinical outcomes
• Project plan and dedicated senior project
  management
• Legal advice
• Transitional Board
• Work streams
• Governance
• Memoranda and Articles of Association
• Consortium Agreement (inc use of DES)
• Business development
• Clinical services

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4. How?

• Board and PEC alignment
• Extensive series of uni- and multi- professional
  events, senior staff seminars
• PPI forum
• External support
• Independent legal advice
• MP
• LA Overview and Scrutiny
• Kings Fund
• ELIC
• DH
• SHA
• Thousands and thousands of man hours
• Communication, communication, communication

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4.Governance structures

• Board
• Lay Chair
• 6 Lay members
• 3 Community services members
• 3 PBC members
• Co-opted members
• Management executive
• PCT and LA representatives
• Multi-professional clinical reference group
• Task and Finish groups with lay representation
• Vested interests excluded from procurement
  decisions

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4. Community engagement structure
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5. Impact

• New form of ownership
• Step change in community involvement
• Continuing importance of personal care
• Multiple information and access points
• Expansion of patient choice for patients
  clinicians and staff
• Quality assured outcome focussed integrated
  services
• New relationship with specialist care
• Public health oriented clinicians
• Emphasis on long term conditions management
• Expanding ambulatory care
• Increased vertical and horizontal accountability
• Innovative relationships (Independent and
  Foundation sectors)

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6. Benefits

• Patients
• Meaningful voice and influence
• Services more directly responsive to patients
  needs
• Shift resources to LTC management
• More seamless services
• Primary care
• More influence
• More responsibility
• Opportunity to integrate professions better
• System
• Improved efficiency and clinical effectiveness
• Alignment of clinical with financial decisions
• Demand management