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What the third sector can bring to the GP commissioning table

With the focus now on commissioning for quality rather than price, Lord Victor Adebowale urges GP commissioners to realise the benefits of commissioning NHS services from social enterprises and the voluntary sector

With the focus now on commissioning for quality rather than price, Lord Victor Adebowale urges GP commissioners to realise the benefits of commissioning NHS services from social enterprises and the voluntary sector

The publication of the most significant piece of NHS legislation since the service's creation 40 years ago has been accompanied by a heated debate about its implications. A common criticism of the Health and Social Care Bill – from the unions in particular – has been it will pave the way for wholesale privatisation of the NHS. However, it is wrong to assume this automatically means our NHS services will be replaced by privately run companies more concerned with rewarding shareholders than improving patient care.

My belief is that social enterprises can offer a viable alternative for emerging commissioning consortia. Nevertheless, it seems that when diversifying providers, the GP community is reluctant to look to them. This concern was verified by a recent ICM poll of GPs commissioned by Turning Point, the health and care social enterprise of which I am CEO. Only 9% of respondents said they would be ‘very likely' to commission services from social enterprises. With commissioning decisions now being placed in the hands of GPs, it is important to be aware of the benefits of social enterprises and of how they differ to private sector providers.

Turning Point has worked in partnership and in competition with numerous private sector providers and has seen the excellent care that they can produce. Still, we remain aware of key differences in the way in which we work i.e. any profit made by private companies goes directly to their shareholders, whereas social enterprises aim to achieve financial viability and public good. Social enterprises deliver what is often described as a ‘triple bottom line' on financial, social and economic aims, investing any profit back into improving existing services, creating new ones and pursuing innovation. The Health and Social Care Bill's emphasis on any willing provider means it is important that quality becomes the primary focus of GP commissioners. GPs will be tasked with commissioning to ensure providers do not set their profit margins at unacceptable levels. Looking to social enterprises and charities should give them some peace of mind that quality will not suffer.

Another benefit of commissioning from social enterprises and voluntary sector organisations is that they have a unique ability to involve communities in service delivery. This is vital if the Government is to deliver on its mantra, ‘No decision about me without me'. Research by the London School of Economics has found that services can be more efficient and cost effective when they are designed and delivered in this way. Turning Point's Connected Care model is based on recruiting local people as community researchers, involving them in the design and delivery of bespoke services and working with local commissioners to integrate health and social care. Research carried out by LSE on behalf of Turning Point found the model could deliver a saving of £4.44 for every £1 invested. When the benefits of improving quality of life are included, a return of £14.07 is gained for every £1 invested. It's a model that works well and for this reason, Turning Point is currently looking at how it can assist GPs in the commissioning of services and community engagement.

Social enterprises have the capabilities of engaging with hard to reach groups and looking at the individual as a whole. My own organisation, Turning Point, has been developing models of service provision which are needs based rather than diagnosis based. These are of potential benefit to GP consortia as they commission services for patients with long term conditions and complex needs such as mental health and problems relating to employment, housing and debt. They are designed to go beyond the traditional boundaries of care, minimising frequent flyers and costly A & E admissions.

The NHS faces great challenges, both financially and structurally. Just as some private companies are adept at embracing change and managing it well, the health service needs to consider how it can absorb such disruption without harming frontline services. This will require commissioners, primary and secondary practitioners to work in better harmony in order to save money where resources can be pooled. It will also call for GPs to reach out beyond their comfort zone, seeking to understand new ways of working which they have had little exposure to. As many are coming to realise, the state/non-state divide is no longer a simple dichotomy between good and poor service. I believe GP commissioning consortia must recognise this too or risk stifling innovation.

Lord Victor Adebowale is chief executive of Turning Point What the third sector can bring to the GP commissioning table

With the focus now on commissioning for quality rather than price, Lord Victor Adebowale urges GP commissioners to realise the benefits of commissioning NHS services from social enterprises and the voluntary sector

The publication of the most significant piece of NHS legislation since the service's creation 40 years ago has been accompanied by a heated debate about its implications. A common criticism of the Health and Social Care Bill – from the unions in particular – has been it will pave the way for wholesale privatisation of the NHS. However, it is wrong to assume this automatically means our NHS services will be replaced by privately run companies more concerned with rewarding shareholders than improving patient care.

My belief is that social enterprises can offer a viable alternative for emerging commissioning consortia. Nevertheless, it seems that when diversifying providers, the GP community is reluctant to look to them. This concern was verified by a recent ICM poll of GPs commissioned by Turning Point, the health and care social enterprise of which I am CEO. Only 9% of respondents said they would be ‘very likely' to commission services from social enterprises. With commissioning decisions now being placed in the hands of GPs, it is important to be aware of the benefits of social enterprises and of how they differ to private sector providers.

Turning Point has worked in partnership and in competition with numerous private sector providers and has seen the excellent care that they can produce. Still, we remain aware of key differences in the way in which we work i.e. any profit made by private companies goes directly to their shareholders, whereas social enterprises aim to achieve financial viability and public good. Social enterprises deliver what is often described as a ‘triple bottom line' on financial, social and economic aims, investing any profit back into improving existing services, creating new ones and pursuing innovation. The Health and Social Care Bill's emphasis on any willing provider means it is important that quality becomes the primary focus of GP commissioners. GPs will be tasked with commissioning to ensure providers do not set their profit margins at unacceptable levels. Looking to social enterprises and charities should give them some peace of mind that quality will not suffer.

Another benefit of commissioning from social enterprises and voluntary sector organisations is that they have a unique ability to involve communities in service delivery. This is vital if the Government is to deliver on its mantra, ‘No decision about me without me'. Research by the London School of Economics has found that services can be more efficient and cost effective when they are designed and delivered in this way. Turning Point's Connected Care model is based on recruiting local people as community researchers, involving them in the design and delivery of bespoke services and working with local commissioners to integrate health and social care. Research carried out by LSE on behalf of Turning Point found the model could deliver a saving of £4.44 for every £1 invested. When the benefits of improving quality of life are included, a return of £14.07 is gained for every £1 invested. It's a model that works well and for this reason, Turning Point is currently looking at how it can assist GPs in the commissioning of services and community engagement.

Social enterprises have the capabilities of engaging with hard to reach groups and looking at the individual as a whole. My own organisation, Turning Point, has been developing models of service provision which are needs based rather than diagnosis based. These are of potential benefit to GP consortia as they commission services for patients with long term conditions and complex needs such as mental health and problems relating to employment, housing and debt. They are designed to go beyond the traditional boundaries of care, minimising frequent flyers and costly A & E admissions.

The NHS faces great challenges, both financially and structurally. Just as some private companies are adept at embracing change and managing it well, the health service needs to consider how it can absorb such disruption without harming frontline services. This will require commissioners, primary and secondary practitioners to work in better harmony in order to save money where resources can be pooled. It will also call for GPs to reach out beyond their comfort zone, seeking to understand new ways of working which they have had little exposure to. As many are coming to realise, the state/non-state divide is no longer a simple dichotomy between good and poor service. I believe GP commissioning consortia must recognise this too or risk stifling innovation.

Lord Victor Adebowale is chief executive of Turning Point

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