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Focus on... GP Provider models

In the third of our in-depth ‘Focus On...’ series, we look at how GPs are taking hold of the reins and providing care to their communities. First, Helen Parker explores what challenges these new provider models create

In the third of our in-depth ‘Focus On...' series, we look at how GPs are taking hold of the reins and providing care to their communities. First, Helen Parker explores what challenges these new provider models create

The Department of Health wants change and innovation in all NHS services. And it believes it can get this by opening up the primary care market to new providers to deliver traditional community services. Many of these are tried-and-tested business models, such as the social enterprise model on page 46. But this competitive environment will also encourage fresh models that bring new challenges with them.

The department may see the opening up of the market as the answer to its quest for innovation. But unlike other markets it is one where community and competition are expected to exist side by side. Can this mix work? Certainly it will require sophisticated commissioning to balance the tension between creating an explicit and robust local market and fulfilling the PCT's duty to work in partnership with local health and social care organisations.

On the providers' side of things, the challenge will be to prove their credibility. Practice-based commissioners may well be faced with a choice of provider organisations. The provider could be either local colleagues, existing providers looking to spread their wings or new entrants into the market.

Each provider will have to produce accountability frameworks outlining the transparent criteria they are going to use to show how well they are doing and so inform procurement decisions. These criteria will need to address such issues as provider credibility in terms of their history of providing services, their responsiveness to fluctuations in demand, the quality of clinical leadership and governance and their approach to patient and public involvement in service development.

Those providers who have chosen to operate under the ethos of social enterprise will need to deliver the associated social dividend that characterises that philosophy if the model is to achieve credibility. It remains to be seen whether those who

are entrenched in a public sector culture, particularly for those who may transfer from NHS provider services into these new organisations, can adopt a different culture and display the characteristics of social enterprise such as the ability to respond quickly to change and individual ownership and commitment to delivering organisational objectives.

So how well is the plan going so far? Certainly lots of different models are emerging. Those with the clinical know-how and necessary business acumen are seizing the opportunity the new market provides to establish exciting ways of working. However, truly sophisticated commissioning across the NHS is still embryonic in development. So at the moment providers are in the driving seat in determining new service and organisational models.

The department is also conscious that there should not be change for change's sake.

Evidence shows that structural change does not equate to service improvement and therefore the new organisations will need to demonstrate tangible patient benefit. Those who continue to deliver the same service to patients but under new professionally advantageous business models may have a short shelf life.

But those that stand the test of time will make a great contribution to patient choice. And if patient choice is allowed to flourish, clinical colleagues in neighbouring organisations – not just the PBC pioneers – may be left with no alternative but to respond to innovation and competition.

A real policy objective.

Helen Parker is senior fellow at the Health Services Management Centre, University of Birmingham

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