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Social enterprises are one of the few ways GPs can protect the NHS

They’re little-known and little-understood, but social enterprises can help GP commissioners keep private profits out of public healthcare, writes Ceri Jones.

The passing of the Health and Social Care Act paves the way for an uncertain future for the way in which the UK's health services are going to be delivered. With the increase in outsourcing to external private contractors leading to fears that the reforms are simply privatisation through the back door, social enterprises remain one of the few effective guardians of our public health services. For years they've been delivering excellent health services without putting profit at the heart of their agenda. But because they've been working under the radar, social enterprises remain poorly understood and are regarded suspiciously by some people working in the NHS.

It is hoped the passing of the Public Services (Social Value) Act in February of this year, which will require public bodies, including GP-led clinical commissioning groups, to consider the social value created when services are commissioned, will help social enterprises compete more fairly for health service contracts. But the challenges to social enterprises delivering healthcare services still remain. With competition from heavily capitalised private companies like Serco and Virgin Care, they could easily be pushed out of the commissioning process. They must do everything they can to prove their worth and effectiveness so that GP-led commissioning groups take them seriously.

The social enterprise sector also needs to set the record straight and rid its association with privatisation of our health services. Unlike private sector providers, their focus is on their social impact, which defines and guides the services they provide. Simply, they are organisations that exist to benefit society, are accountable to local communities and their staff.

The benefits of using a social enterprise are difficult to argue against – a service provider whose profit goes back into its services and the community its serves just makes sense. It steers the NHS toward a locally accountable, staff controlled service model. But most importantly, health services purely exist to benefit patients and communities, and not to line shareholders' pockets.

Unfortunately we're still seeing private company providers block out social enterprises and scoop up multi million pound contracts to deliver our health services.  Virgin Care recently secured a deal worth £500 million to deliver contracts including community nursing across much of Surrey – beating Central Surrey Health, a social enterprise with a gleaming track record.

Central Surrey Health are one of the many ‘spin-outs' to emerge within the past fifteen years – teams of public sector staff moving out and setting up independent organisations and selling the services back. Since their ‘spin-out' in 2006, they've provided therapy and community nursing services in central Surrey. Productivity has increased annually. In 2009 alone, the social enterprise has streamlined operations identifying and removing inefficient systems and processes that were taking up clinical time that could be better spent on direct patient care.

They continue to improve, in 2011 delivering 10-44% gains in productivity alongside quality improvements for patients - most notably waiting times. In 2006 the waiting time to see a physiotherapist was over 16 weeks; now it stands at less than five – three weeks less than NHS Surrey's target. And it's not just services that are improving. Staff absence rates have halved from 3.55% in 2011 to less than 1.74% in 2012.

By setting up as a social enterprise, Central Surrey Health have not only been able to maintain and improve existing services and patient care, but importantly when they increase productivity and make savings it is the community that benefit, not the shareholders.

It is now time for social enterprises to step in and demonstrate that there is real value in an alternative business model.  It doesn't have to be public vs private; profiteering does not have to be an accepted consequence of healthcare transformation. 

Ceri Jones is Head of Policy at Social Enterprise UK

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