Thursday, March 11, 2010

Primary health care as a social business

Social business is starting to make some entries into health care in the UK. A primary care operation in Surrey is set up as a employee owned, not-for-profit cooperative.

All the profits made by the NHS Primary Care Trust facility is put back into the business to increase care and service to customers. Employees do give up any profit-sharing to be a part of the company, but are more empowered to make decisions than in another business with a hierarchical management system.

From The Telegraph, writer Tracy Corrigan talks to NHS Primary Care Trust founders Jo Pritchard, and Tricia McGregor.

It is easy to see why a not-for-profit company is a better deal for the taxpayer – any efficiencies are ploughed back into the health system, rather than servicing dividends for shareholders. But if the success of the company does not benefit employee-owners – or managers – financially, what does the notion of ownership really mean?

“It’s very satisfying – we can make things happen and co-owners’ talents are being liberated,” says Mrs McGregor. Both women exude a radiant enthusiasm rarely apparent in the private sector, let alone the NHS. Mrs Pritchard points out that most people who join the health care professions are motivated by a desire to help patients. Some never lose that commitment, but the system does not nurture it and many are worn down by bureaucracy. “Things don’t happen because it’s someone else’s responsibility, and decisions aren’t made,” she says.

At Central Surrey Health, staff are empowered to deal with the problems. “The question is not what are you going to do about X or Y, but what are we going to do about it,” says Mrs Pritchard. Recently, the business has automated its referrals system, getting rid of cumbersome paperwork. This has resulted in lower costs, and shorter referral times.

That attitude perhaps owes less to the notional 1p share in the company that each employee holds, and more to the culture within the business. There is a lack of hierarchy and plenty of opportunities, through staff forums, to discuss how things are – and should be – done.

“I’m more engaged and more involved, and I know more about the business,” says Suzy Marsh, a podiatrist who transferred from East Elmbridge and Mid-Surrey Primary Care Trust. Financially, she agrees, she is no better off, but staff have kept their NHS pensions, which was, not surprisingly, “the biggest concern during the transition period”.

Politically, with inevitable public-sector cost cuts over the next few years, both political parties are espousing structures to improve the efficiency of the health service. Mrs Pritchard and Mrs McGregor are convinced that the Central Surrey Health model is replicable. We will soon find out. Twenty similar businesses are about to be created under the Department of Health’s “right to request” scheme, which allows all front line PCT staff to apply to set up as social enterprises to improve services. The first wave of approvals includes dental services in Bedfordshire and mental health services in North East Lincolnshire.

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