The document discusses potential changes and stakeholders in primary care in the UK. It proposes moving more services like diagnostics and minor surgery from secondary to primary care to improve access and efficiency. This would require new primary care provider models that are larger and better able to facilitate changes. One such model is mutual providers which are corporately robust, maintain the NHS ethos through stakeholder involvement, and ensure accountability. The role of PCTs would transition to focus on smart commissioning rather than direct provision. Facilitating new mutual providers could help achieve the goals of improved services and management of long-term conditions closer to home.

1. Primary Care Stakeholders
Ehsan Kabir Solicitor

2. Change in Primary Care
• Develop health improvement
• Manage long term conditions better
• Link primary care with social care
• Move much of diagnostics/outpatients
from secondary care
• Provide most minor surgery

3. Primary Care Provision Now
• GP Practices
– 9,000 practices
– Usually partnerships
– 30,000 GPs 3,500 single-handers
• Some PCTs
– With salaried doctors
– Where GP practices don’t cover
• PCT role to commission services

4. PCT Features
• Quangos
• Staff have NHS Culture
• Some are good providers
• Most are not
• Responsible for commissioning
– What to commission
– How much
– From whom

5. GP Practice Features
• Partnerships less attractive
– 40% of those qualified become principals
– Limited career pathways
– Difficult to introduce innovation
• Ageing GP population
– Acute problem in London
– But a growing problem elsewhere
• Deprived areas worse off

6. Primary Care Stakeholders
• The public (patients, taxpayers)
• The GPs
– Owners of the providers
– They are the key providers
• Other Health professionals
– Community nurses
– Health visitors etc.
• The PCTs
– Commissioners
– Employers
• The rest of the NHS – DH/SHA/Government

7. What The Public Want
• Services that are:
– Easily accessible
– Quick and efficient
– Trustworthy
– Consistent
– Make them better/avoid illness

8. From Governance
Actively involved in:
• Membership development
• Public relations + perceptions
• Develop a Governor job
description
• Develop the mutual expectations
of the Board/ COG
• Assisting formal consultations
• Overview of effectiveness
• Communications with public and
working with media
• Governor networking
• Consultation with board
Want more information on:
• Understand trust strategy
• Patient education – member
information by clinician / health
promotion
• An understanding of staff issues
• Monitor’s view
• Trust/Hospital performance
reports
• Financial reports to an agreed
level of detail
• Briefings from health professionals
• Budget for membership
• Co-ordination of contact with
patients / CPPHH / forum
• NHS information

9. Primary Care Changes
• PCTs to stop providing
• Need for better configured businesses to
achieve change
• New entrants to provision will bring
contestability
• Opportunities for existing providers and
allied staff

10. New Providers
• New corporate entities
• Still independent of state
• Bigger and more capacity
• Able to achieve changes outlined
• Could be either conversions, new
independent entrants or new mutual
businesses

11. Mutual Providers
Board
Stakeholder
Council
GPs
Health
Professionals
Public/users

12. Why Be Mutual?
• You get choices
– Consumer or professionally driven
– Or a mix
• It is corporately robust
– Strong corporate governance
– Empowers the right people to the right level
• Maintains the NHS ethos
– An extension/modern interpretation of the NHS
– It is less threatening – value is re-circulated
• It is accountable
– Membership drives accountability - demonstrably

13. The PCT
• Commissioner
– Not just the contract letter
– Make contractors accountable to their users
– Design patient pathways
• Not provider but enabler

14. What Should Be Done?
• Government should state its preference clearly
for a diverse sector of providers
• It should understand the importance of smart
commissioning as the key to financial
accountability
• It should identify how to encourage the growth of
new providers – not wait for it to happen
because it will not
• It should facilitate business support to NHS
professionals who wish to establish new mutual
providers

15. The Result
• Diagnostics & minor surgery closer to
home
• GPs get tools to tackle health inequalities
• Management services and corporate
competence assured
• The users are built into the service
providers

16. Thanks