Transcript Clinical Leadership in Brent - Out-of

‘Out of Hours 2005?’
a whole system review of the future scope and
organization of OoH Services
Laurie McMahon
Office for Public Management
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
the project partners.…
• National Association of GP Cooperatives
• Primary Care ‘OoH’ Team, Department of Health
• Office for Public Management
• people like you!
the purpose.…
• develop ‘plausible’ organizational models
• establish criteria by which to judge them
• ‘whole system’ commentary on benefits/risks
the three phases.…
a 'core group' design meeting
a ‘whole system’ evaluation event
a 'white board’ session to distil the learning
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
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
the main themes…
accountability
governance
local sensitivity
potential to grow
integration
the organizational models
GP Equity Model
Private Company Model
‘PCT–as-Provider’ Model
Public Interest Company Model
the organizational models
GP Equity Model
Private Company Model
‘PCT–as-Provider’ Mode
Public Interest Company Model
Acute Trust Provider Model
the organizational models
GP Equity Model
Private Company Model
‘PCT–as-Provider’ Model
‘Public Interest Company’ Model
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
Some PIO differences….
• a mutual company
• a public interest company
• a community interest company
A question…..….
Is a PIO part of the NHS ‘family’?
the organizational models
GP Equity Model
Private Company Model
‘PCT–as-Provider’ Model
Public Interest Company Model
_
The OoH Abacus
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there are always ‘downsides’………
…. it didn’t work so neatly!
the GP equity model
Plus sides
detailed knowledge of locality/ needs
strong mutual spirit
attractive to staff
local clinicians central
D
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
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
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
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
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?
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?
the GP/PIC model
U
DDOWNS
PIC status does not exist
commercial sector does not ‘understand’
ability to raise capital?
the winner…..?
principle of mutuality
public perceptions of ‘profiteering’
independence of ‘the state as provider’
potential to grow
local sensitivity and accountability
In discussion…..….
• PCT provider as temporary ‘safe default’ – a ‘holding’ strategy
• plan to migrate
2004
‘OoH’
GP’s
The Migration…..
‘multi service’
‘24/7’
2006+
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!
‘Out of Hours 2005?’
a whole system review of the future scope and
organization of OoH Services
Laurie McMahon
Office for Public Management