Social enterprise

Social enterprise ‘costs’ PCT £600,000

Posted on December 17, 2009. Filed under: News stories, Social enterprise |

Healthcare Republic | Neil Durham | 17 December 2009

Plans by a Surrey PCT to hive off NHS services into a social enterprise could cost almost £600,000, according to Unite/CPHVA.

It believes the sum, £4 a head for Kingston’s population, could be better spent on services, such as speech and language therapists, health visitors, physiotherapists and community nurses.

Using a Freedom of Information request, Unite discovered that £181,000 has been spent in 2008/9 on becoming ‘an autonomous provider’ and ‘business ready’ organisation. A further £79,000 has been earmarked for this ‘externalisation of provider services’ for 2009/10.

If the social enterprise is not eligible for VAT refunds for the purchase of goods and services, the extra cost will be £300,000. The NHS is currently exempt from VAT.

A total of £18,000 has already been spent on ‘marketing and branding’ for the proposed social enterprise, which will be a commercial organisation, able to win and lose contracts to provide services to the NHS for a limited period of time, according to Unite.

The union believes the creation of a social enterprise contravenes health secretary Andy Burnham’s recent policy announcement that the NHS is the ‘preferred provider’ for services.

Karen Reay, Unite national officer for health, said: ‘Money that could be going on services, such as speech and language therapists, is being spent on management consultants and the bureaucracy to create the structures for the social enterprise.’

A Kingston PCT statement said: ‘We are disappointed that Unite continue to misrepresent this positive development for Kingston residents. The social enterprise is being established to benefit the local community in receipt of healthcare services. This innovative development does not contravene Andy Burnham’s recent policy announcement. In fact a recent letter from the DoH was sent to the first wave of 20 ‘Right to Request’ schemes, of which Kingston is one, reinforcing the freedoms awarded to staff working in this new type of organisation allowing them to promote innovation and efficiency to serve their patients better, free of the normal constraints of NHS bureaucracy.

‘An independent review showed that a social enterprise was the most effective way to deliver high quality and better value health services for people in Kingston and five-year financial modelling shows our plans are robust.’

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Creating an NHS family of shareholders

Posted on December 7, 2009. Filed under: News stories, Social enterprise | Tags: , |

Pulse | Practical Commissioning | Focus on…..Becoming a provider | 7 December 2009

A GP-owned private company is coming into its stride with provision and has just secured a £30m urgent care contract with two other providers. Vale Health’s commercial director John Butler explains

When the Department of Health launched practice-based commissioning in March 2005, the 21 GP practices that made up the Vale of Aylesbury PCT in Buckinghamshire were among the first in the country to embrace the concept. We were also early adopters of the potential of combining commissioning with providing.

The initial move was that the practices set up the United Commissioning Collaborative as the local commissioning body – a not-for-profit limited liability partnership. Once that was achieved, a small group of us began to look in depth at the providing side.

We had two reasons for wanting to provide services. First, we knew GPs were the best people to know what’s needed locally. Second, we realised that if we set up our own provider company, we would not only be able to design the services but actually deliver them as well, which had to be an enormous advantage in terms of ensuring the quality of care.

We started out with a social enterprise ethos, so setting up as a standard for-profit company was a secondary consideration. But it made sense that those involved should be able to profit from their efforts.

In May 2006, Vale Health Limited was registered as an independent legal entity.

To get started we needed seed funding, but realised that whatever investment was put into the company was ‘at risk’ money.

If the venture was a flop, there were no guarantees there would be a return.

With this in mind, we offered shares to the GPs and their staff, just to see if they wanted to invest. About 110 GPs and practice staff did so, buying between one and 10 shares at £100 each. The amount any one person could buy was capped so that one individual would not have undue influence.

Limiting the shareholders to members of the NHS family also facilitated the transfer of staff from the NHS to us. It meant we could employ NHS clinicians part-time without them losing their NHS pensions. When they’re working for us they’re still paying into their pensions, which removes a major barrier.

In the initial tranche we raised about £40,000, which enabled us to get started, then with a second share issue we raised more money. A board of directors including local GPs was set up to oversee the company and embarked on tendering for work.

Conflicts of interest

The issue of conflict of interest that profit introduces is real. Conceivably, to make extra money, we could divert people to our services who don’t need them. But we work very closely with the PCT as a partnership and are audited by them, which introduces stringent checks and balances. In addition, the clinicians we employ make their own professional clinical judgments that we can’t influence.

At the time, the DH was actively encouraging ‘a plethora of providers’ with the idea of promoting competition to raise quality and lower costs, so the PCT was fine with the private company idea. But it was keen that we clearly differentiated between commissioning and providing.

When we started off, Wendover GP Dr Johnny Marshall (see box, page 35) was chair of both arms but it became necessary for him to withdraw from chairing Vale Health to make the distinction clear. We haven’t gone back to the overlap we started with, but there is now a greater understanding with the PCT that the two sides working closely together is no bad thing.


Although we had the cash to get going, we initially found it difficult to work as cost-effectively as established organisations such as Community Health Bucks, the provider arm of the PCT. Our cost per service was high because we didn’t have the infrastructure behind us. We struggled with issues like this, which took an inordinate amount of time to surmount.

It has been a real saga to get the whole thing onto a contractual basis but the introduction of the Standard Community Health Service Contract simplified matters and we are just in the process of signing that off.

The delay has meant that, until now, we haven’t been able to offer contracts to clinicians working for us. The lack of contracts has also made it difficult for us to grow as a company because NHS contracts count for a great deal with banks and other funding sources.

However, we were fortunate on another level. Because PCTs weren’t commercially experienced when we started, the tendering process was easier then than it is now.

After an initial struggle, we eventually got a couple of services up and running.

Our pulmonary rehabilitation services began with nine programmes within the Vale of Aylesbury PCT in 2006. Further programmes have been rolled out across the rest of Buckinghamshire. Each programme was for eight weeks with a maximum of 10 patients.

In April 2008, our musculoskeletal community assessment and treatment service was launched across the whole of Buckinghamshire.

Both services were set up on a shoestring staff-wise – the day-to-day running of the company is carried out by two people including me and we subcontract most of the clinical administration work to the provider arm of the PCT.

In our musculoskeletal service, six specialist clinicians work for us part-time on a self-employed basis and we use specialist physiotherapists and podiatrists who are subcontracted from Community Health Buckinghamshire.

As we were given short notice to launch the musculoskeletal service it was a difficult start. However, we’re now up and running at 10 sites the length and breadth of the county with patient convenience in mind.

Annual running costs are hard to estimate at present because the business is constantly developing. The company has yet to meet its target profit for shareholders.

Growing the business

Having survived the initial difficulties, we knew we had to get more business to spread our overheads. At that point, the urgent care contract for Buckinghamshire came along to cover out-of-hours as well as attendance and admissions avoidance, which on its own involves coordinating many different services. It’s a complex single contract – possibly the most complex one ever put together.

It was far too big for us to do independently so we collaborated with providers in the south of the county, independent healthcare provider Harmoni and Chiltern Health, another GP practice-funded provider. This was partly because the costs and risks in tendering are high.

Completing the pre-qualification questionnaire, just to get on the tender list, can cost several thousand pounds. And the tender itself costs many tens of thousands of pounds.

Another thing that has become clear is the need for people who are skilled in tender work. GPs who are thinking of forming provider companies should be aware of this and not be afraid of collaboration.

Although competition was stiff, we won the tender on quality and value for money and started work on the contract in late summer last year. It was signed in early November and will come into play in March next year for an initial five years, worth more than £30m in total.


There are no clear figures yet for the outcomes of our musculoskeletal service but we are diverting significant numbers of patients out of secondary care and into community-based care. This is more accessible for patients, it benefits the local health economy and patient feedback shows that car parking is usually easy.

An evaluation of the pulmonary rehabilitation pilot carried out in 2005/6 showed the following (we would expect results to decline over the full 18-24 months):

• number of chest infections reduced by 65%

• number of hospital admissions cut by 53%

• number of GP visits for exacerbations of COPD reduced by 80%

• increased exercise tolerance

• 21% average increase in distance walked

• 88% of patients were still exercising

• course was a positive experience for 94% of patients

• 95% of patients had increased confidence in managing their condition.

Since then the service has extended and we are currently collating results that look encouraging.

The future

Among our future plans are extending services beyond the geographical confines of the Vale of Aylesbury, still using our in-house skills.

We are convinced our for-profit model is the way forward. Public services do not organise things cost-effectively, but the private company will be more efficient.

If they were in the hands of the NHS the services we provide would cost more than we charge.

Ultimately, if the ethos is to provide free care at the point of delivery, it doesn’t really matter who provides that care as long as it’s of the highest possible quality.

John Butler is commercial director and company secretary of Vale Health Ltd

The GP’s view

Dr Johnny Marshall is a GP in Wendover, Buckinghamshire, chair of the NAPC and a founder of Vale Health. Here he shares the lessons learned during the challenging process of setting up Vale Health’s services
‘Our services – particularly the community musculoskeletal service – have been a real success, but it’s been a difficult process. The PCT has been learning as it’s gone along and we are now heading towards a much faster service procurement.
We’re now looking at expanding our current services. It’s still very expensive to tender for new ones but with the urgent care contract under our belt we can work on expanding what we have.
Once you start looking at much bigger contracts, you realise you need to work in partnership. But you can still accelerate service design while keeping local ownership, which is very important.The reality is commissioning and providing are not separate. There is clear blue water between the organisations (Vale Health and United Commissioning). But you need to be careful that separation is not for separation’s sake. The two sides have much to learn from each other.The message to other GPs wanting to try a similar arrangement is that this is not without risk. You need to make sure you go in with your eyes open and plan very carefully. You need a sense of forward planning and make sure you think beyond step one.

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Health clinics open in Eastbourne

Posted on November 25, 2009. Filed under: GP-led health centres, News stories, Providers, Social enterprise | Tags: , |

Bexhill-on-Sea Observer | Annemarie Field | NHS East Sussex Downs and Weald | 25 November 2009

TWO NEW clinics opened in Eastbourne this week.

A new state-of-the-art health centre at Eastbourne Railway Centre opened on Tuesday and offers a ‘walk in’ service to see a GP or nurse from 8am to 8pm, seven days a week.

And on Thursday the newly refurbished Eastbourne Dental Clinic in Terminus Buildings opened after a two month refit costing almost £500,000.

Eastbourne MP Nigel Waterson was among those who were given a tour of the new walk in health centre which has taken the place of a former sports bar on the station concourse.

The walk in service will be open to everyone, regardless of whether they are registered with the health centre practice, or with another GP surgery, or not at all.

This will mean it can be used by tourists, other visitors to Eastbourne, people who work but do not live in the town, as well as people who are not registered with a GP for whatever reason.

South East Health Ltd (SEHL) will be running the centre and working closely with local GPs to ensure that the services offered by the new health centre are properly integrated into the local health care system and operate as effectively and efficiently as possible to deliver the best outcomes for local people.

The MP also opened the Eastbourne Dental Clinic on Thursday afternoon.

The project is part of the effort by NHS East Sussex Downs and Weald to improve local NHS dental services by commissioning new and enhanced services.

The new look clinic now has three resident dentists using up to date facilities including three operating rooms and a decontamination room.

The practice will offer a wide range of NHS treatments, including hygienist appointments.

Senior Partner Dr Esmail Harunani said, “We want to give all our patients top quality treatment and we will welcome all new patients who want to be seen on the NHS.

“We have re-vamped our facilities and the services we offer and we are aiming to further build our reputation for giving people excellent care and service”.

The Eastbourne Dental Clinic will offer sessions to help people, especially children, prevent problems with their teeth such as decay and tooth loss.

Free oral health seminars will be on offer every month, open to all, and will cover why mouth and tooth care is so important for people of all ages, right from the very young to older people.

People who may have difficulty in getting NHS treatment are also encouraged to visit the practice, especially anyone who has not been seen by a dentist for the past two years.

The clinic’s dental team is specially trained in helping patients who are nervous or anxious.

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GPs and nurses lead DoH-backed social enterprises

Posted on November 24, 2009. Filed under: News stories, Social enterprise |

Healthcare Republic | Neil Durham | 24 November 2009

Three-fifths of the social enterprises the DoH is providing £30,000 backing for are led by either GPs, nurses or a combination of the two.

All frontline staff working in PCTs can set up a social enterprise to improve their services under the ‘right to request’ scheme. The first wave of projects include a wide range of services, including those for the homeless, children and young people and mental health services.

As well as £30,000, each group is given a dedicated mentor and access to professional development opportunities that will help ensure their social enterprise is a success.

Care minister Phil Hope said: ‘Frontline staff see first hand how effective local services are, what works and what doesn’t. I want staff to use their specialist skills and knowledge to transform local services and improve the health and wellbeing of patients and users.’

GP-led services:

  • Salford PCT: Healthy living centre delivering a range of public health services;

Nurse-led services:

  • Leicester City PCT: GMS for homeless people including substance misuse services;
  • Derby City PCT: Family nurse partnership: health visiting programme working with vulnerable teenage parents;
  • Norfolk PCT: Primary care services and management of long-term conditions for patients in custodial/offender care environments;
  • Mid Essex PCT: community hospitals, district nursing, health visiting, physiotherapy and community dentistry;
  • South East Essex: district nursing, long-term conditions management, community dentistry, podiatry, health visiting and school nursing;
  • Barking and Dagenham PCT: walk-in centre;
  • Bromley PCT: urgent care centre;
  • Kingston PCT: primary and community care services;

GP/nurse-led services:

  • Bedfordshire PCT: general medical care services, home visits, minor surgery, ante and post natal care and cervical cytology;
  • Bromley PCT: integrated primary and community care services.
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NHS services will be a social enterprise

Posted on November 17, 2009. Filed under: News stories, Providers, Social enterprise | Tags: , |

Third Sector | By David Ainsworth | Kingston PCT | 17 November 2009

Kingston Primary Care Trust to launch separate provider

A major social enterprise will be created before the end of the year out of a south-west London NHS trust, as part of a drive to change how the NHS is structured.

Kingston Primary Care Trust said it expected to launch a separate provider arm called Your Healthcare, with a turnover of £25m and a staff of 500 nurses, therapists and support staff. These will be transferred from the PCT as soon as it receives permission from NHS London, the capital’s strategic health authority.

Your Healthcare will become an independent social enterprise providing a wide range of services, said a spokeswoman for Kingston PCT.

The PCT’s remaining 100 employees will continue to work for the trust on more strategic functions.

“The organisation is already operating with a shadow board, awaiting formal confirmation of the new structure,” she said. “We’ve been working towards this since last July and we’re expecting final sign-off this year.”

Hull PCT has also announced plans to make its provider arm into a community interest company, known as Hull City Health Care Partnership, but it has been delayed by a legal challenge from a patient, who is seeking a judicial review of the decision.

Both decisions were taken in response to a Department of Health decision that PCTs should separate their commissioning and provider arms.

Mark Johnson, managing director of TPP Law, which specialises in social enterprise development, said progress had been less positive in other PCTs. “Many people who would like to develop social enterprises feel they lack support from PCT boards,” he said.

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How our social enterprise model moved PBC up a gear

Posted on November 17, 2009. Filed under: Commissioner, News stories, Social enterprise | Tags: , |

Pulse | Focus on…..Social Enterprise | 17 November 2009

Dr Bill Tamkin explains how becoming a social enterprise helped his PBC cluster get ahead in the game

Turning our PBC group into a social enterprise company has given us more clout with providers and the PCT. Manchester Practice-Based Commissioning (South) Ltd grew out of our consortium of 26 practices known as the South Manchester PBC Hub, which was launched four-and-a-half years ago.

There was a long history of like minded working between practices. When PBC came in, the PCT encouraged us to start working as a consortium but reorganisation in 2004/5 meant a dramatic slowdown.

Most of the people we knew in the trust disappeared and we were left in limbo as the three trusts merged into one – NHS Manchester. There was a lot of frustration from GPs and we felt we would be more effective if we had a formal set-up.

The decision to opt for a social enterprise format was both practical and philosophical. We had seen it working in Stockport and we wanted charitable status – to be a company for the community rather than being about profit for shareholders.

Having now created the social enterprise, we have the potential to hold a real budget for our 160,000 patients and an agreement to provide commissioning support to the PCT with a devolved budget of £1m.


We wanted to focus on three key relationships:

• with the PCT

• between our practices

• with the main providers.

Members felt we needed some clarity about what the new PCT expected from us and what our role was.

There was also a need to firm up relationships between practices. We are all independent and most of the time work in isolation – a more formal relationship where we all agreed to move in the same direction would be very powerful in terms of improving the quality of primary care as well as helping us negotiate with the acute sector and the PCT.

GPs had very little ability to negotiate with providers on behalf of patients. There were daily frustrations about the struggle to get good care. Tales of inefficiency, long waits, duplication of tests and futile outpatient appointments spurred us on.

Sometimes trusts would refuse to see patients because they were in the wrong patch – Manchester is one of the largest metropolitan areas in the UK with a population of more than 2.5 million and there are a number of large, powerful providers, from the University Hospital South Manchester to the Manchester Royal Infirmary, Pennine Acute, Central Manchester and others. We had no influence over these trusts as individual GPs but as a corporate entity we would be able to negotiate on behalf of 160,000 patients.

There was also a need to make sure the new organisation had longevity rather than simply relying on a few enthusiasts. We wanted to set up something that would be sustainable in its goal of improving the health of the population we care for.

And we wanted to look to the future – whichever political party comes into power, it’s clear healthcare spending can’t keep going up and up. PBC is currently the only game in town to tackle this. And as a legal entity we have the potential to hold a real budget for our 160,000 patients.

What kind of model?

We looked at various structures and took advice from people who had been there and done that, such as our neighbours in Stockport PBC who had set up a social enterprise – a business or service with social objectives where surpluses are reinvested, rather than being driven by the need to maximise profit for shareholders.

We wanted commissioning to be credible with our patients and the PCT. The idea of joint ownership, all being in this together, seemed to fit our approach.

But setting up the organisation was a cumbersome process. From the initial idea four years ago, it has only been in the past 18 months that things have started to happen.

We took the idea to one of the PBC group’s quarterly meetings where all the 26 practices came together and supported the plan. But it took a year to win hearts and minds at the PCT, which was frustrating.

We had to keep plugging away, building relationships and showing we had a robust vision. It was about understanding the issues and the pressures on both sides.

The current financial difficulties in the NHS tipped the balance in our favour.

To set up the organisation and register with Companies House we needed legal advice. It cost about £35,000, including employing the legal firm as company secretary. In future years we plan to have this role in house. We funded this through freed-up resources gained over the first couple of years of our consortium’s work.

We went for a particular type of social enterprise structure, the Industrial Provident Society. It’s a community-based organisation where all practices are members, which suits our egalitarian, inclusive commissioning ethos.

We had to hold our first AGM where we needed a quorum to vote for board members. Trying to get GPs to leave their surgeries was a challenge – the old line about herding cats comes to mind – so we made it clear the project couldn’t go forward without that commitment. Then it was hard work to get people to fill in the membership forms the right way. It’s something that inevitably goes to the bottom of the ‘to do’ list in a busy surgery – even my own practice managed to fill in the forms wrong! But we got there in the end, with a lot of chasing and support from PCT staff.

Nowadays there’s a lot more help available for people who want to go down the same route, from the Department of Health social enterprise support unit to the legal firms who specialise in this area.

How it works

We are a membership organisation where the number of members each practice has is proportionate to list size. The member could be a GP, nurse or practice manager.

I’m the chair and one of five GPs on the board. We also have five practice managers and one lay member on the board. All our GP leads have specific roles such as long-term conditions, finance and contracting, and we bring in expertise in specific clinical areas as needed. Each practice manager board member is linked to a GP lead.

There are quarterly meetings to which any staff member can come, which focus on clinical issues and service redesign. We usually have representatives from each practice and the relevant clinical leads.

As chair, I visit all the practices regularly to monitor performance and talk about PBC. It’s very much bottom-up, not top-down – peer pressure is important. Comparative data helps GPs know how they are doing and helps everyone feel they are all in this together.

We don’t provide services – we are about commissioning. Once we’ve identified a need and developed a patient pathway, we create a service specification. Procurement is handled separately by the PCT’s business case approval process. The aim is to get business cases approved within eight weeks.

Cultural change

At first the new PCT was largely paying lip-service to PBC – we had to win hearts and minds. It’s always tricky for people to give up power but there has been a big cultural change and we are now working much more closely together.

Relationships between the PBC group and PCT have developed as we’ve spent time together. We both now understand the two worlds we work in – so when we refer, we have an idea what the options are and what they cost, and the PCT understands how GPs work. There is better connectivity between the contracting and financial world of the PCT and the ‘coalface ‘ of general practice.

There’s a real sense of joint ownership. The financial pressures have really concentrated minds and the PCT realises PBC is part of the solution, not the problem.

Day to day

We have a service-level agreement with the PCT covering processes and responsibilities. Some 16 PCT staff are seconded to us to provide data, contracts and finance support. We have a management budget of £150,000 for cover for board members and clinical leads – I spend four sessions a week working for the company, and the other board members are covered for one session each.

The amount of work continues to grow – it often feels as if every piece of paper the PCT conjures crosses my desk. Board members and clinical leads complete timesheets so we can demonstrate the scale of work involved.

Our clinical leads for areas such as diabetes and COPD go into the PCT regularly and look at activity and other data, as well as providing feedback to the PCT, practices and the regular business meeting. Practice managers meet PCT teams and PCT staff go into practices to support them with prescribing and with using data.

The three chairs of each local PBC consortium attend PCT board meetings – we are guests rather than board members but it is clear the PCT takes us very seriously.

We have an overall devolved budget of £1m, which includes money for the local incentive schemes. These include peer review of referrals, prescribing targets and attending quarterly meetings.

New services
We’ve commissioned the ScriptSwitch prescribing management system. It sits on the practice computer and flags up expensive drugs, hospital-prescribed drugs and provides alternatives. For example some generics are now more expensive than non-generic preparations and this is flagged and can be changed with one click.

When we started out, there was a lot of frustration about growing demand from nursing homes and patients being discharged from hospital with little information. Now we’ve commissioned a team of a consultant geriatrician plus two GPs with nursing support, who go into nursing homes and actively manage patients. We are seeing a considerable reduction in home visits and admissions– in some cases visits have reduced by 50%. It was a hard slog, taking two years from idea to launch because of PCT reorganisation, but is now making a real difference.

We’ve also commissioned a minor surgery service. We found there were 1,700 procedures a year where patients were going into hospital for simple things such as removal of sebaceous cysts. Now there are three GP surgeons who carry out minor surgery in the community. Patients are very pleased that they don’t have to wait for ages and pay to park.

The future
We are currently working on ideas about commissioning better anticoagulation, ENT and phlebotomy services. The first is still based in outpatients, where people wait for hours (at an expensive tariff) for something that should be done more economically in the community.

One of the big performance issues is in orthopaedics, where the 18-week waiting time target is being breached and work is being sent out to the private sector at above tariff rates. We have drawn up a specification for a new service and are currently waiting for business cases to come in. Forming our company has been hard work but rewarding and has given ‘shop-floor’ general practice the chance to work in the macro world of the NHS.

Dr Bill Tamkin is chair of Manchester Practice-Based Commissioning (South) Ltd

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Safety in numbers: the rise of the GP federation

Posted on November 17, 2009. Filed under: Arm's length providers, Federations, News stories, Providers, Social enterprise | Tags: , |

Pulse | By Nigel Praities | 17 November 2009

It’s two years since the RCGP proposed its ‘roadmap’ for general practice, which envisaged practices working together as federations, pooling skills and resources to broaden the range of services on offer in primary care.

Many at the time thought it would go the same way as the Middle East roadmap for peace. Yet increasing evidence is emerging that GPs are experiencing a major shift in the way they work, some more voluntarily than others.

Nigel Praities investigates the growing move towards new models of working and asks if federations are now the only way forward.

Where does the idea of primary care federations come from?

The RCGP’s ‘roadmap’ was largely designed to steal a march on the market-based approach being spearheaded by Lord Darzi and his NHS Review.

The concept was one of primary care federations giving patients better access to services with change being championed locally by GPs, rather than through ‘one-size fits all’ plans from central Government.

Initially federations were seen as nothing more than glorified practice-based commissioning hubs, but a 2008 paper from the RCGP was crucial in putting more flesh on the bones of the federation concept.

Federations, the paper said, could give practices ‘economies of scale’ they could not achieve otherwise, by sharing back-office functions and directly employing managers and nurses to provide new services.

It gave a list of characteristics a federation should have, including a formal legal structure, an executive management team and a written public constitution.

What evidence is there that federations are beginning to evolve?

There are no official numbers on primary care federations in the UK but, anecdotally at least, it seems more practices than ever are working collaboratively.

Pulse has uncovered evidence of practices linking up in all areas of the country – from the centre of post-industrial Sheffield to the rural heart of Worcestershire.

Trailblazing schemes in Croydon and South London have been followed by other partnerships, with some practices forming limited companies or provider arms.

The schemes involve nearly 300 practices in a wide range of different models, from collaborations with private companies to organic growth from successful PBC hubs.

In Sheffield is a group of 90 GPs working in an area with high deprivation and social need that is heading towards a federated model.

It directly employs specialist nurses to run diabetes and ENT clinics in the community and is working on several schemes to bring other services closer to home, such as midwives to provide obstetrics clinics in GP surgeries.

All the 28 practices in the consortium sign an agreement and work with centrally employed practice managers. They have also formed a provider company this year, Central Care Sheffield Ltd, to take on their projects and save administrative costs.

Paul Wike, Primary Care Lead Manager at the consortium, says: ‘It is safety in numbers, they have another 26 practices standing should-to-shoulder.’

What different models have emerged?

As in Sheffield, many of the practice groupings have grown organically out of PBC clusters or consortiums.

GPs in Brent have recently set up a federation council that contains representatives from the five PBC local clusters. It sits on an executive council with the PCT and looks at how services can be commissioned all over Brent

Dr Ethie Kong, a GP in Brent and member of the federation council, says it gives GPs a powerful voice in how primary care services are commissioned for areas such as improving health inequalities and care for long-term conditions.

‘Some of the needs are common and some specific to the locality. We work within our clusters, and across clusters, and Brent-wide we liaise with the PCT.

‘This means we have local autonomy as well as borough-wide co-operation,’ she explains.

Services are currently provided by the PBC clusters themselves under a not-for-profit social enterprise model, but this may change in the future.

Other areas are working closely with private companies to form provider companies. A network of 22 practices in Worcestershire have formed a ‘GPCo’ through a 50:50 partnership with the company Assura.

Assura provides money to set up the company and shares the profits with the GPs. A statement from Assura says it enables GPs to ‘exploit the economies of scale that a national organisation brings’ by reducing the costs of service design, bid management and service implementation.

‘Due to the fact Assura operates nationally, all of its members are able to benefit from its bulk purchasing power of equipment and utilities, as well as understanding how other localities provide services more efficiently,’ the company says.

PCTs are also seeing the benefit of making practices work together. NHS Tower Hamlets has recently dangled a massive £12million carrot in front of their practices to fund the development of new care pathways and ‘networks’ of GP practices.

As Pulse revealed last week, the PCT – in one of the poorest parts of the country – brought in the external consultants McKinsey to assess their primary care services.

They recommended a 40% increase in funding for primary care and that this should be used to develop networks – with hubs for each care package – and would eventually include specialists, local voluntary organisations and the borough.

Are there any dangers for GPs?

One risk is that the schemes will cause GPs to surrender the protection of their nationally negotiated contracts.

In Tower Hamlets, the additional investment in primary care is dependent on all practices switching to APMS. That could be a bad decision in the long-term, as their contracts could be rewritten at the whim of the PCT or handed to private providers.

The involvement of private companies could also open up GPs to criticism they are profiteering rather than seeking to improve the care of patients.

Dr Michael Dixon, chair of the NHS Alliance, says the way GPs develop their federations will be crucial to whether they survive or not.

‘There are some really big questions here that general practice has to ask itself – are we in it to make a short-term profit or for the long term to make services more responsive to local patients?

‘I think a social enterprise is the best model, because it is really important the extension of services is seen as something done for local people, rather than tabloid headlines saying we are “fleecing” local people again.’

There is also a danger federations will bite off more than they can chew. They are able to take on more risk than an individual practice, as it can be spread more thinly, but this could backfire.

A PBC federation of 32 practices in Bexley made £4m worth of savings after being given real budgets for prescribing last year, but they also took on responsibility for 54% of any overspend, which could have cost them tens or hundreds of thousands.

What does the future hold?

If Tory plans are anything to go by, GPs could see themselves with much greater responsibility for commissioning and real budgets written into their contracts from next year.

This could push those not currently in a federation into thinking about how they can work closer together and become more business-like in the way they organise commissioning.

The NHS Alliance is due to launch a paper this month on developing ‘local care organisations’, extending the federation model to secondary care and other partners.

This model – similar to the networks planned by Tower Hamlets – could see the traditional barriers between different aspects of healthcare being blurred, ideally with GPs driving the changes.

This is the best case scenario, but whatever happens GPs working on their own is likely to be a thing of the past. The formation of federations may be the only way to ensure GP practices remain the basic unit of care for patients, albeit with risks.

As Dr Dixon warns: ‘Whichever party is in power next year, there will be a much bigger drive to emancipate these organisations. Whatever happens there will be change, and GPs should be developing these systems in readiness.’

RCGP chair Professor Steve Field is in no doubt federations are the future.

‘This is the way forward,’ he says. ‘The most important thing is strong GP leadership and that patients are at the centre of it.’

Increasing numbers of practices appear to be heeding that call.

How GP Federations are progressing across the country

1. Bexley: PBC federation of 32 practices that was responsible for making a £1.4 million saving in prescribing cost last year and is now looking at working with consultants to develop new pathways of care

2. Brent: Initially a PBC cluster of 67 practices, it has now progressed to have a GP Federation Council and is involved in all mainstream commissioning and planning

3. Worcestershire: 22 practices working in a ‘limited liability partnership’ with the private company Assura to develop PBC opportunities

4. Lincolnshire: Cluster of 14 practices that is registered as a ‘limited provider company’ and has worked to ensure their local hospital survives by having primary care-led acute medical beds, a GP-led A&E department and holding additional diagnostics in the community

5. Croydon: Led by RCGP fellow Dr Agnelo Fernandes, it is made up of 16 local practices covering 140,000 patients. Recently it won an award for its diagnostics-in-the-community project, providing ultrasound, echocardiography and direct-access MRI

6. Surrey: Epsom Downs Integrated Care Services is a collaborative venture involving a federation of 20 practices in Surrey. It has established nearly 30 new community clinics, enabling over half of out-patient consultations to take place closer to home

7. Sheffield – Consortium of 28 practices that has been working on schemes to improve prescribing and community services for chronic pain and COPD. Has just set up their own provider company – Central Care Sheffield Ltd

8. South London – RCGP vice-chair Dr Clare Gerada’s group of five GP practices across Southwark and Lambeth has set up new musculoskeletal clinic and gynaecological services and was mentioned as a good practice example in the Darzi review

9. Tower Hamlets – Revolutionary plans for primary care ‘networks’ with a hub for each long-term condition, with GPs working with specialists and community/social care services and local voluntary groups

10. Kingston – The Kingston Co-operative Initiative is a not-for-profit limited company overseeing PBC on behalf of 27 practices. Runs an education and support service and a GP-led referral management scheme. Also developing a service provider arm.

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The nuts and bolts of setting up a social enterprise

Posted on November 16, 2009. Filed under: News stories, Social enterprise | Tags: , , , , , , |

Pulse | 16 November 2009

Emma Wilkinson takes a look at what social enterprises can do for PBC

What is a social enterprise?

Social enterprises are businesses, but unlike limited companies that make profits to line the pockets of shareholders, they are driven by environmental or social principles, and surplus funds are reinvested to further those goals. So the community benefits from any profits made.

The Social Enterprise Coalition ( says there are some 62,000 social enterprises in the UK with a combined turnover of at least £27bn.

Mo Girach, social enterprise lead for the NHS Alliance, says: ‘There are three elements to social enterprises. They are designed to tackle social objectives, such as health inequalities. Any profits made are reinvested in the local community. And local people and staff have the ownership of their services.’

If you generate the bulk of your income from trading and use most of your profits to further social or environmental goals, your organisation might be classed as a social enterprise.

Models for a social enterprise include:

• A community interest company (CIC) – a legal form created specifically for a social objective, overseen by the CIC regulator to ensure it does not deviate from its mission and that its assets are protected (

• Industrial and provident society (IPS) – this is the usual form for co-operatives and community benefit societies, and is democratically controlled by members.

• Companies limited by guarantee or shares – these can have a social mission written into their memorandum and articles of association, but are not regulated.

• Group structures and charitable status – in these cases the tax breaks associated with charitable status can be an important factor.

How do they differ from a limited company?

The key difference is that a social enterprise is set up to fulfil a social goal rather than a financial goal. But social enterprises are businesses and need to make a profit to be competitive, remain afloat and to keep investing in their social vision. They are not an easy option for someone wanting to avoid the legal technicalities and governance arrangements of a limited company.

Dr Mike Dixon, chair of the NHS Alliance, says: ‘It’s a way of setting out business principles but making sure the business is there for the patients and not for shareholders.

‘The steps to setting one up are similar to those for a limited company – you need a lot of advice, you need to decide your basic vision and what sort of partnership it’s going to be, and who is going to be a part of it.’

Mr Girach adds: ‘A true social enterprise has in its constitution that profits are reinvested and there are no shareholders. That is a key point. There might be shareholders but that is in terms of ownership rather than profit so they are more social enterprise members.’

What are the advantages for PBC?

Setting up a commissioning group under a social enterprise model means GPs are less likely to be accused of lining their own pockets – a suggestion that has surfaced repeatedly in the past few years. It may also be an easier route for organisations wanting to work as both provider and commissioner.

Dr Dixon explains: ‘It shows that the profit motive is not an issue but at the same time gives a businesslike approach.

‘There’s another element that’s quite important if you are a commissioner.

I think it allows a certain blurring of boundaries when it comes to also having a provider role.

‘Social enterprises are becoming more common in PBC – not rapidly but PBC has been a slow process – and they are very logical.’

Richard Oliver is business manager at Nene Commissioning, a not-for-profit community interest company of 76 practices in Northamptonshire that started life as a limited company.

‘Trying to get 76 practices under one umbrella is a challenge and there was a huge amount of discussion about the structure that might be suitable. We started off as a limited company because it was a known legal entity but we decided that didn’t reflect why the organisation got together. So we looked around to see how we could demonstrate it wasn’t just a money-making exercise for doctors but that it was about patients.

‘The model that most clearly suited what we already had but that could move us into the social enterprise arena was a community interest company. We retained nominal shares and there is limited liability but at the same time the money is retained for use in the business.’

Any disadvantages?

Disadvantages to being a social enterprise may have more to do with misconceptions surrounding their function rather than a problem with the business model itself.

‘I think people don’t understand the calibre of credibility and true benefits they bring and think they’re small businesses,’ says Mr Girache.

‘The other problem is commissioners don’t embrace social enterprises and tend to go with what they know, for example the foundation trust, which are mutuals.

‘There is a lot of work to be done between commissioners and providers in raising awareness of social enterprises. This is something the Department of Health’s social enterprise unit is working on.’

Dr Dixon agrees: ‘A lot of people see social enterprises as rather woolly and something done by people in socks and sandals rather than business suits, but that’s not true and there are lots of examples of successful social enterprises. Look at John Lewis.

‘The other thing is that there are people in social enterprises who are not as they seem. It is easy to be a wolf in sheep’s clothing. If it does take off we will have to look very closely at social enterprises and check people are who they say they are – not one thing masquerading as another.’

Why has the government been so keen on social enterprises?

It is not just the current government that is keen on PBC groups setting up social enterprises, with the announcement of a £100m pot for health and social enterprises in 2007. The Conservatives have also hinted they may be the way forward, with talk about social responsibilities as well as a focus on the ownership agenda.

‘I think there are a number of reasons the Government is keen on social enterprises,’ says Mr Girache. ‘The ownership factor is a big reason. Being able to say to people “over to you – deal with it”. There is an incentive for people to get a little bit back and also a feeling that in some policy areas, such as health inequalities, things haven’t moved. PCTs have been working on these for 20 years and sufficient progress just hasn’t been made. Social enterprises are an alternative.’

So what are the first steps in setting one up?

Nene commissioning’s Richard Oliver says the first thing to do if you are interested in setting up a social enterprise is to make sure the PCT is on board with the proposed change. Then you need to decide what kind of organisation you want to be.

‘Do a lot of preliminary work before you see a solicitor as there is a lot of information out there, for example on the Social Enterprise Coalition website, to inform your decision. Then you need to get legal advice, and I would recommend choosing a solicitor with national experience.’

Dr Mike Dixon adds: ‘You need to form the right relationship first before you do anything else. There is no point hoping to gel with practices that don’t talk to each other.’

Are there any pitfalls?

With the appropriate business and legal advice and a clear plan of what the company wants to achieve, the process should be fairly straightforward, but there are potential problems to consider before taking that leap.

‘People often think social enterprises are not businesses but a form of charity that doesn’t have to make a profit – this is nonsense,’ says Mr Girache.

‘You need to think who your competitors are and what you have over them. Social enterprises focus on quality rather than feeding shareholders’ pockets.

‘The other thing is to do proper market research. You will have to deal with some aggressive providers and if you don’t understand the market and what your niche is, you will fail.’

Dr Dixon advises: ‘Don’t expect organisational form to be the solution to everything and don’t be too optimistic about what you can achieve; be realistic.’

Mr Oliver adds: ‘When it comes to legal advice, make sure you only fund what you need to as you can incur a lot of costs.’

What about funding?

To get off the ground, in addition to PCT resources, there are various sources of funds for social enterprises, including patient capital, grants and favourable loans, details of which can be found in the Good Deals 2009 Social Investment Almanack.

In June 2009, Social Investment Business took over the management of the DH’s social enterprise investment fund, and along with Partnerships UK is responsible for the £100m fund (£70m is now left) for start-up and existing social enterprises in the health sector over the next three years.

But the NHS Alliance would like to see more incentives to catalyse the social enterprise model.

Dr Dixon explains: ‘There are sources of funding available, for example from the social enterprise unit at the DH, but we produced a report three or four months ago pointing out there should be preferential treatment for people funding social enterprises in the form of tax advantages, the ability to get capital and VAT relief, in order to make social enterprises build a bit faster. It needs to be pushed further.’

Richard Oliver says: ‘Our funding comes through the PCT like any other PBC cluster and is based on population size – which for us is 650,000.

‘The advantage of being so big is that our money is pooled so we can fund a team working on our behalf rather than having to do it ourselves in house.

‘We looked at it and realised there was no way we were going to be able to do that and the day job of looking after patients, but by pooling the resources we can have a much bigger team – there are 10 people here – running the PBC side of things.’

Emma Wilkinson is a freelance journalist

More information

The Third Sector has published The Social Investment Almanack to showcase the different types of social investment.

It includes a comprehensive directory of social investors, finance providers and support organisations as well as many examples of different models.

Good Deals 2009: The Social Investment Almanack Deals 2009: The Social Investment Almanack


Focus on… social enterprise

Pulse | 13 November 2009

This month’s Focus on… looks at social enterprise models and what they can do for PBC. Here, Rebecca Chaloner outlines the Department of Health’s commitment to the concept.

Social enterprise models are about connecting with and investing in communities, empowering staff and working in partnership to deliver innovative services.

The social enterprise sector is diverse, with more than 6,000 schemes estimated to be delivering health and social care in the UK. This figure continues to rise as growing numbers of health and social care professionals investigate social enterprise as a viable option to tackle unmet needs and address health inequalities.

Sharing the same public-sector ethos as the NHS, social enterprises reinvest surpluses into services and the community and run on business principles that improve quality and efficiency.

Clinicians are committed to delivering high-quality patient care, and some may feel frustrated by a system and processes that restrict their ability to achieve the change they desire. Social enterprise, with its scope to innovate and be flexible to local need, is one way to empower clinicians to deliver care that is truly responsive to patients’ needs.

Social enterprise is not for everyone, nor is it for all services. However, it is an important option for those looking for a way to deliver a wide range of health and social care services as we move towards a more responsive, modern and targeted healthcare system.

Social enterprise is a way for PBC groups not only to support the commissioning of services but also to provide services in a way that enables them to address unmet local needs. It also offers the potential to forge a new partnership between professionals, users and the local community.

The Department of Health wants to ensure that social enterprises are in a position to add value to current services and that commissioners, through a range of providers, can offer choice and quality to patients, as well as value for money.

In line with its commitment in the NHS Next Stage Review, the department is encouraging the creation of new social enterprises to deliver primary and community services. To facilitate this, PCT staff have been granted the ‘right to request’ to set up a social enterprise from their PCT. This allows staff to explore setting up a social enterprise to deliver services if they believe that gaining the independence and flexibility will enable them to improve services and outcomes for users. The department is now working with a number of ‘right to request’ proposals and supporting them in developing their ideas to transform services.

The journey towards establishing a social enterprise requires determination and vision but there is support available through the £100m social enterprise investment fund (SEIF). The SEIF provides business advice as well as seed funding for start-up social enterprises and development loans for existing businesses. The fund is available to anyone in England operating, or wishing to start up, a social enterprise in health and social care.

The department is committed to supporting social enterprise as a way to increase social cohesion in communities, improve health and wellbeing and reach beyond traditional means of delivering care.

Rebecca Chaloner is head of the Department of Health’s Social Enterprise Unit

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PCT rejects staff ballot on social enterprise transfer

Posted on November 13, 2009. Filed under: News stories, Social enterprise |

Healthcare Republic | Neil Durham | Kingston PCT | 13 November 2009

A Surrey PCT’s decision not to hold a staff ballot over proposals to create a social enterprise ‘rides roughshod over government policy’, according to union Unite/CPHVA.

The union says Kingston PCT’s plan to hive off NHS services into a social enterprise contravenes health secretary Andy Burnham’s announcement that the NHS is the ‘preferred provider’ for services.

Unite had asked managers at Kingston PCT to hold a ballot for staff about whether they backed transferring to a social enterprise but said this had been rejected.

Peter Storey, Unite regional officer, said: ‘The right to request a social enterprise was made by the management without any involvement of the staff or unions.

‘Mr Burnham has already said that the NHS is the preferred provider of choice. This means that outside providers, such as a social enterprise, can only be asked to tender if a trust is deemed to be failing and has not taken remedial measures. Kingston PCT is now riding roughshod over government policy.

‘Services in Kingston are not failing, so why are we dismantling the NHS?’

Siobhan Clarke, managing director of provider services at Kingston PCT, said: ‘Everything we’ve done so far has been in partnership with staff and union representatives, and the department of health has made it clear it still fully support social enterprises, which are still NHS funded services.

‘We’re already providing fantastic services and plan to carry on doing that, with even more involvement from staff and service users as they will become members of the organisation. This move is about the community deciding where public resources are spent.

‘We’ve always factored VAT into our five-year financial modelling and business plan, which has shown that Your Healthcare will be a financially viable organisation. The VAT charges will be offset by the efficiencies across the rest of the organisation.’

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Aetna UK

Posted on November 11, 2009. Filed under: Commissioner, Social enterprise | Tags: , , , |

Aetna UK | accessed 11 November 2009

Aetna UK is dedicated to supporting PCTs and other commissioning authorities to improve patient outcomes and reduce overall costs. Aetna UK combines UK-based operations with U.S. expertise in order to customize solutions for its clients.

Being ‘commissioners’ ourselves, we truly understand what it takes to maximise health gain within available resources. We bring significant breadth and depth of experience from the U.S. and are well-positioned to deliver a differentiated perspective.

Aetna UK is part of an on-going expansion of Aetna’s international businesses, with London serving as the operations centre for both commissioning services and Aetna’s UK, Europe, Middle East and Africa expatriate business. 

Vincent Sai is Vice President and Managing Director of Aetna UK and is based in our London offices. Meet the Aetna UK Management team

Aetna Corporate Overview

Established in 1853, Aetna has been a trusted name in American healthcare for over 150 years. Integrity, reliability, and commitment are key to everything that we do. We are experienced in commissioning services and offer a broad range of health management services and health insurance products.

We have relationships and contracts with more than 783,000 healthcare professionals and facilities in the US. Globally, we have relationships with over 740 facilities, including 90 in the UK.

Our clients include public sector and government sponsored programmes, employer groups and individuals. Consistently, surveys recognise us as one of the most ‘doctor-friendly’ healthcare companies.

Partnership is key to our success. We work with some of the most complex organisations in the world today and believe that success can only come by working alongside our clients in order to create customised, practical solutions to solve their healthcare needs.

For more information, visit .

The Aetna Way

At Aetna we put the people who use our products and services at the centre of everything we do and live by a core set of values.


Customer Profiles

NHS South Birmingham

NHS South Birmingham and Aetna have entered a partnership — the first of its kind, to redefine how healthcare is delivered in South Birmingham. This unique public-private partnership brings together expertise from two world-class organisations that will share best practices to implement innovative programmes and services for the benefit of patients in South Birmingham. We are calling the partnership “Out in From Together” which sets the tone and direction for how we want to work — partnering to lead the way to improve health and health services in South Birmingham. Read our Q&A to learn more about the partnership and key areas of delivery. For more information about NHS South Birmingham, visit


LONDON | 8 September 2009

NHS South Birmingham and Pathfinder Healthcare Developments launch two pioneering services to tackle urgent health needs and risks

NHS South Birmingham and Pathfinder Healthcare Developments CIC (PHD cic) have partnered with Aetna Health Services UK to develop new ways of working to improve health outcomes in their respective communities. These two partnerships demonstrate how public and private entities can successfully work together, and have resulted in the launch of two new services that support each organisation’s larger strategic initiatives.

The first service, a telephone care management programme, is a nurse support service designed to help patients manage their long term health conditions. The second, an online health risk assessment tool, gives people a picture into their current and future health status, and provides them with an achievable action plan to address their greatest health risks. Both provide the National Health Service (NHS) and General Practitioners with innovative approaches to managing health care costs while improving quality through personalised care and support.

NHS South Birmingham and Aetna have teamed together to redefine health care delivery in South Birmingham. NHS South Birmingham is transforming the way health care is delivered to their local population and developing skill sets that have a positive and long-term effect on the population’s health.

“This is an exciting opportunity to learn from a company who has proven expertise in delivering quality services, effectively targeting and engaging individuals and, importantly, managing cost to improve patient experience and give them more choice around health services and their individual care,” said Moira Dumma, Chief Executive, NHS South Birmingham. “This requires collaboration across all stakeholders, and our unique partnership with Aetna unlocks the potential within the health economy to share best practices, improve commissioning expertise and engage the entirety of our population, including those most in need.”

Pathfinder Healthcare Developments (PHD) is a community interest company operating as a social business. PHD has grown from an innovative partnership between three large inner city GP practices based in the Sandwell area. Their work with Aetna supports a larger project to implement innovative new practices, services and ways of working to support their diverse patient populations and the quality of primary health care services.

“Aetna’s bespoke approach to working is what is most appealing,” said Dr Niti Pall, Chair, PHD. “There was no ‘off-the-shelf’ solution that they tried to implement. Rather, they listened to our needs, worked with us to devise solutions and areas of support, and most importantly, co-develop solutions that were appropriately translated for the British market.”

Having both a primary care trust and social enterprise company engage Aetna demonstrates Aetna’s ability to work with different types of organisations, and how best practices from the private sector can be successfully translated to the public sector. It also points to a shift in the way primary care trusts and providers are thinking about delivering additional health services—and how they can jointly address the needs of their populations by utilising the experience of the private sector.

As one of the leading diversified health care benefits companies in the U.S., Aetna has been recognised for its advancements in medical management and health information technology. Recently, the company has embarked on exporting these innovations to support health care reform across the globe.

Notes to editors:

1. The online health risk assessment tool is one of the most comprehensive on the market available to the general public. Upon completing a questionnaire about health and lifestyle habits, the tool will generate a risk score. An action plan is also automatically generated that includes suggestions on how to address current health conditions and also reduce or even prevent future ones. Additionally, the tool offers “healthy living programmes” that can be taken online to address individuals’ immediate health needs. Among the included programmes are “Stress Relief,” “Get in Shape,” “Cancer Fighting” and “Healthier Diet.” South Birmingham residents can access South Birmingham’s bespoke tool by registering on; Patients of Smethwick, Hollybush and Cape Hill Medical Centres can access the online tool on

2. Over 17.5 million people in the UK have a long term condition (Improving Chronic Disease Management. Accessed December 4, 2008 at, 45% of which who suffer from more than one. For patients with more than one long term condition, health care costs are six times higher (DeVol R, Bedroussian A. An unhealthy America: The economic burden of chronic disease.The Milken Institute. Oct 2007.). 80% of GP visits relate to long-term conditions. The steep rise in diagnoses of long term conditions and increasing costs for providing care for these patients are forcing a change in the way that commissioners and GPs provide health services in such a way to help manage rising costs while still providing excellent and quality services.

3. Aetna’s care management programme is a telephone-based support service for patients who have two or more long term conditions. Delivered by registered nurses, the service provides patients with additional support to help change their health outcomes by changing their health behaviours. Powered by Aetna’s leading data analytics and informatics tools and backed by an experienced clinical team trained in motivational interviewing techniques to deliver highly personalised care, the service aims to close the care gap by connecting patients to resources to support their journey to a healthier lifestyle.

4. Aetna is a leading health care company, commissioning services for approximately 37.2 million people worldwide through a broad range of health management services and health insurance products. Aetna has relationships with more than 1.3 million health care professionals around the globe, demonstrating the company’s commitment to providing customers and individuals with access to safe, affordable, high-quality health care. Building on its more than 150-year history, Aetna is recognised for its dedication to cooperating with doctors and hospitals, employers, patients, public officials and others to build a stronger, more effective health care system.

5. Aetna UK was established in early 2007 to offer dedicated commissioning support services to Primary Care Trusts (PCTs), and was appointed to the Framework for procuring External Support for Commissioners (FESC) later that year. In 2008 Aetna was appointed to the Practice Based Commissioning (PBC) Development Framework to provide support for PCTs and PBCs to help them strengthen and build on local support arrangements for practice based commissioning.

6. NHS South Birmingham commissions services for a population of 383,000 people. Currently our Primary Care Services include 65 GP practices, 170 General Dental Practitioners, 71 community Pharmacies, and 80 local optician premises including domiciliary services. We try to keep health care close to home and offer a range of nursing and therapy services to support this through your local GP. We look at the health of the entire local population and address issues specific to our area. Public health is an important role and includes issues such as poverty, obesity, diet, exercise, smoking and other factors which impact on your health.

7. Pathfinder Healthcare Developments (PHD) is a Community Interest Company (cic) based in the West Midlands concentrated in the Sandwell area. PHD is a progressive and innovative provider of extended primary care services, specialising in meeting the needs of inner city multiracial populations. It currently provides a wide range of services to a population of just over 25,000 across three practices and three sites through a Personal Medical Services (PMS+) contract and an Additional Personal Medical Services (APMS) contract with PCTs. It has a track record of delivering high quality services, often leading the way locally in the development of services, particularly to marginalised groups. PHD has a track record of excellence (recognised by the UK Department of Health) often leading the way in the development of services, particularly to ethnic minority communities, and to marginalised groups. The UK Department of Health has recognised the standards we achieve and the innovation we apply.


London | 2 December 2008

Appointment brings together expertise of Aetna, PricewaterhouseCoopers and the Royal College of General Practitioners

Aetna (NYSE: AET) announced today that it has been appointed by the Department of Health as one of five suppliers on the Practice Based Commissioners (PBC) Development Framework.  The goal of the Framework is to promote excellence in practice based commissioning by supporting the development of core competencies within PBCs and Primary Care Trusts (PCTs).

“Practice based commissioning is a critical element to achieving world class commissioning aspirations.  We are delighted to be recognised as a leading player in such an important area,” said Vincent Sai, Vice President and Managing Director of Aetna UK.

Recognising there is no “one size fits all” solution, Aetna will team up with PricewaterhouseCoopers and the Royal College of General Practitioners (RCGP) to deliver development services.  The breadth and depth of this relationship combines the perspectives of one of the world’s largest commissioning organisations and health analytic experts; one of the world’s leading change management and organisational development consultancies; and clinical insight and leadership from the largest of the Royal Colleges. 

“The unique combination of skills of Aetna, PricewaterhouseCoopers and the RCGP also reflect Aetna’s commitment to bring the best resources to support PBC development and foster continued improvement and innovation within the NHS,” continued Mr Sai.

Services offered range from building analytic and commissioning skills, organisational and leadership development, to improved engagement of key stakeholders including clinicians, patients and the public.  Ultimately, the value that the partnership brings is its experience in creating bespoke solutions that can help PBC consortia prioritise and develop foundational capabilities for sustained success.


Notes to Editors:
1. Aetna UK will partner with PricewaterhouseCoopers and the Royal College of General Practitioners to provide support for PCTs and PBCs to help them strengthen and build on local support arrangements for practice based commissioning.

2. Aetna is a leading healthcare company, commissioning services for approximately 37.2 million people worldwide through a broad range of health management services and health insurance products. Aetna has relationships with more than 1.3 million healthcare professionals around the globe, demonstrating the company’s commitment to providing customers and individuals with access to safe, affordable, high-quality healthcare. Building on its more than 150-year history, Aetna is recognised for its dedication to cooperating with doctors and hospitals, employers, patients, public officials and others to build a stronger, more effective healthcare system. Aetna UK was established in 2007 to offer dedicated commissioning support services to Primary Care Trusts (PCTs). As one of only six U.S.-based suppliers selected to provide advisory and commissioning services, Aetna UK is approved by the Department of Health through its sponsored Framework for procuring External Support for Commissioners (FESC).

3. PricewaterhouseCoopers has an extensive track record going back over 30 years of providing authoritative advice and assistance to a wide range of public and private health organisations, including the Department of Health and other government departments, SHAs, commissioners and providers. PricewaterhouseCoopers also works in collaboration with other key stakeholders such as Monitor, the NHS Confederation, and quality regulators, such as the Royal Colleges and the Audit Commission, to add insight and expertise in key areas of policy and delivery.

4. The Royal College of General Practitioners (RCGP) is the academic organisation in the UK for general practitioners. Its aim is to encourage and maintain the highest standards of general medical practice and act as the ‘voice’ of general practitioners on education, training and standards issues. Founded in 1952, the RCGP is a relatively young organisation with an outstanding record of achievement. Milestones in its history include the establishment of vocational training in general practice, the setting up of clinical guidelines for doctors, the expansion of research into general medicine practice and the promotion of primary care.

Aetna Positioned to Expand in England: Appointed by Department of Health to the ”Framework for Procuring External Support for Commissioners” (FESC)
–Aetna to offer range of services to support Primary Care Trusts–

HARTFORD, Conn | BUSINESS WIRE | 5 October 2007

Aetna (NYSE: AET) announced today that it has been appointed by the Department of Health as one of the suppliers on the Framework for Procuring External Support for Commissioners (FESC) to offer commissioning support to Primary Care Trusts (PCTs) in England. The FESC will provide PCTs with easy access to a framework of expert suppliers who can support them in undertaking their commissioning work.

The NHS provides health care coverage for all citizens in England, based on need, not ability to pay. It is the largest organization in Europe and one of the largest employers in the world, with more than 1.3 million employees. Originally created in 2002, PCTs are free-standing local organizations within the NHS responsible for ensuring that community health needs are met. In consultation with community stakeholders, PCTs develop health care plans that best meet the needs of their individual patient populations and commission services with providers.

Services that Aetna will offer to local PCT managers include a wide range of support, ranging from specific tasks such as designing medical management programs, also known as demand management, to comprehensive contracting and procurement of services.

“We are very pleased to have been selected as a supplier on the framework by the Department of Health in England,” said Ronald A. Williams, Aetna chairman and CEO. “We believe we have a range of skills that complement existing experience within Primary Care Trusts, and are excited to be given the opportunity to help to strengthen health care delivery in communities across England.”

Aetna’s proven experience in managing health care quality and cost to a budget through effective contracting and procurement techniques, information analysis and its partnership approach to program design were key components of the company’s successful appointment as a supplier for the FESC.

According to Martha Temple, vice president of Aetna with primary responsibility for the company’s international businesses, “Our goal is to form partnerships to create integrated solutions that address the differing health challenges and health needs of PCTs across England. We will do this in a way that truly addresses the top concerns of both PCTs and patients.”

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 34.9 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life, long-term care and disability plans, medical management capabilities, and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans and government-sponsored plans in both the U.S. and internationally. Aetna’s international businesses also include Aetna Global Benefits(R), Aetna’s expatriate benefits division that focuses on providing comprehensive benefit solutions to employees working, travelling and living in over 100 countries.

CONTACT: Media Contact:
Katherine Lee Balsamo, 860-273-2707

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Union calls for staff ballot on social enterprise plan

Posted on October 27, 2009. Filed under: News stories, Social enterprise |

Healthcare Republic | Neil Durham | Kingston PCT | 27 October 2009

Staff at a Surrey PCT should be balloted over proposals to hive off NHS services into a social enterprise, according to union Unite/CPHVA.

The call to Kingston PCT follows the announcement by the DoH that the NHS should be the ‘preferred provider’ of choice.

Unite describes social enterprises as commercial organisations which can win and lose contracts to provide services to the NHS. It fears social enterprises may have to pay VAT, a tax from which the NHS is exempt.

Peter Storey, Unite’s regional officer, said: ‘It is clear that social enterprises are a leap in the dark in terms of provision of services; the employment conditions and pensions of NHS staff that could be severely eroded, or even lost; and the viability of the financial model proposed, if VAT is charged on its services.

‘You could get a situation where a visit by a health visitor to a young mum suffering from postnatal depression will result in the organisation having to pay VAT when it comes to internal accounting. That is unacceptable.’

Kingston PCT was unavailable for comment.

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The future of West Essex Community Health Services

Posted on October 26, 2009. Filed under: Arm's length providers, Integrated care, Providers, Reports/papers, Social enterprise |

NHS West Essex Community Health Services | September 2009 | accesssed 26 October 2009 (pdf)

West Essex Community Health Services (WECHS) is the current provider arm (arms length trading organisation) of NHS West Essex. 

What is a social enterprise?

Social enterprise is a “badge” that a company or charity can adopt that brings certain benefits and says certain things about the ethos of the business. 

The key defining characteristics of a social enterprise are that it is not for profit, it works for the public benefit and any surpluses it makes are re-invested in the organisation. Beyond that social enterprises can be modelled in different ways to support the specific aims and purpose of the organisation. 

What all social enterprises share is an enterprising, innovative, business-based approach to achieving social and environmental aims.

A social enterprise can access monies through the Social Enterprise Investment Fund (SEIF) which an NHS trust is unable to do.

What is a not for profit company and how might it work?

The company is owned by staff who could be the shareholders. It is possible that it would be structured as a
company limited by shares of a nominal value, for example £1 each. The shares would be owned by staff and would not be available for resale. This means that staff could be the true owners of the business but without any personal financial risk. 

Shares could not be transferred and this would mean the business could not be bought by a third party. Any money saved or made by doing things better, differently, or by marketing developing services and products, could be re-invested for the benefit of patients and staff. If the company made a loss, it would need to look for greater efficiencies, just as an NHS trust would have to.

An alternative to a social enterprise

• PCT provider unit (current arrangement) 

This would be an arms length trading organisation (ALTO) within the PCT, led by a provider board and accountable to the PCT. This is essentially the structure which has been in place since April 2008. This is unlikely to remain an option given the long standing national policy to separate the commissioning and provider functions of PCTs. How long we could stay as an arms length trading organisation is unclear. There has been a public verbal statement from the Department of Health that ALTO will not be acceptable after April 2010, but this has not yet been enshrined in policy or guidance – the PCT Board are clear that this is not a long term option for WECHS.

• Community foundation trust (CFT)

CFTs are independent organisations accountable to Monitor, an independent regulator, and not the Department of Health. They are legal entities in their own right – the PCT Board consider this not a viable option as WECHS is considered too small an organisation to become a CFT in its own right and would have to consider joining with another provider arm to pursue this option. This would not necessarily encourage the focus on local communities or integration with primary care which is at the heart of commissioning intentions. In any case there is little chance of many more community foundation trusts being established and the infrastructure costs of a new trust may in any case be unaffordable given the recession.

• Horizontal integration with other community care services

Integration of care services provided by the PCT with other community care services provided to the same population by other government agencies, and in particular by the local authority. This is not an option the PCT Board currently believes serves the needs of their commissioning plans. Currently many local authorities are transferring their directly provided services to the private or third sector. But not in partnerships with local GPs

• Vertical integration with an acute trust 

Integrate the PCT’s community services with acute care provided by Princess Alexandra NHS Trust or a neighbouring acute foundation trust – the aim of the commissioning plan is to transfer services from acute care to community and primary care settings not to increase the size of portfolio of acute services.

• Horizontal integration with a non acute trust for example mental health 

While these trusts often have a strong community focus which might be beneficial they also cover large geographical areas and are usually very specialised in what they do. This might detract fromlocally sensitive services.

• Managed dispersal

Through the procurement plan, services are gradually transferred to the organisations successfully awarded a contract. It is likely though that WECHS will need a temporary host while this happens as NHS West Essex are clear that they will not remain the hosting organisation.

• Integration with primary care forming a social enterprise model

Community services would be integrated with primary care services within west Essex. Staff and potentially GPs establish an organisation themselves which provides community services. This may be registered as a social enterprise, a not for profit organisation, working for the public benefit, that can re-invest any surplus in services – this is the PCT Board’s preferred option at this time and on which staff are now being consulted through this consultation paper.

• An integrated organisational model led by local GPs

This would be a company which would have a contract with the PCT. Apart from the social enterprise model described above, this is the only model that would secure the same benefits for patients of a locally focussed integrated service provider. For this reason, this is the PCT’s present preferred alternative option if staff do not want to establish a social enterprise.

Big Changes For Staff And Patients At Saffron Walden Community Hospital

Saffron Walden Reporter | 23 October 2009

A SHAKEUP in the way health services in the region are run could mean big changes for staff and patients at Saffron Walden Community Hospital.

Some of the services currently delivered by NHS West Essex – the primary care trust (PCT) which covers Uttlesford – could become part of a new independent organisation.

If the plan gets the go-ahead it would mean that the hospital, as well as many other services such as district nursing and health clinics, will become a separate not-for-profit company known as a social enterprise.

Branch chairman of Unison (the union for public sector workers), Terry Ward, believes the proposals could give a raw deal to employees and service users.

“If this split happens then it’s possible that the PCT will buy cheaper services from elsewhere, rather than the facility at Saffron Walden, which makes a mockery of the idea of a community hospital,” he said.

“And staff, who have worked for the NHS for a long time and want to continue to work for the service which they are very proud of, are now being asked to privatise themselves.”

“A lot of resources are being used to push the social enterprise model and we want to make sure that employees are fully aware what they are voting for.”

There are a number of alternatives to privatisation and staff will be given a vote on December 9, after a 90-day consultation, on whether to adopt the idea.

The vote concerns the future of the provider arm of the PCT, known as NHS West Essex Community Health Services, which has an annual income of £34 million and employs nearly 1000 people.

It provides health services in community hospitals, clinics, health centres, GP surgeries, children’s centres, schools and other locations across Uttlesford, Harlow and Epping Forest.

Managing director Vince McCabe said: “What ever happens, local people will continue to receive all their NHS services as they have before, free at the point of delivery, paid for out of the public purse and commissioned by NHS West Essex.”

He added that the social enterprise model would be the best way to “protect and develop” services for the future.

“It would give our frontline staff greater freedom to make decisions closer to patients,” he said. “They would also have a bigger say in how things are run.

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Herefordshire’s work scheme provider, Bizmatch, folds

Posted on October 18, 2009. Filed under: News stories, Providers, Social enterprise |

Hereford Times | 18 October 2009

ONE of Herefordshire’s best known social enterprises is facing liquidation.

Bizmatch, which provides employment opportunities for vulnerable adults, ceased trading this week.

Bizmatch is the trading arm of Hereford-based Workmatch, which gives work preparation and training at its Coningsby Street headquarters.

Herefordshire Council has been working with Workmatch this week to support those affected by the breakdown of Bizmatch. Both the council and NHS Herefordshire purchased services from the charitable company.

Around 70 clients were receiving the service, with 30 of them eligible for support from the council’s adult social care team.

“We are reassuring everyone who is eligible for support that we will be finding alternative means of continuing a service for them,” said Sara Keetley, head of adult social care for Herefordshire Council and Primary Care Trust.

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Managers accused of failing to consult on social enterprise plan

Posted on October 14, 2009. Filed under: News stories, Social enterprise | Tags: |

Healthcare Republic | By Jonn Elledge | NHS Kent | 14 October 2009

NHS managers in Kent have been accused by Unite/CPHVA of pushing through a radical reorganisation of services ‘by stealth’.

Unite accuses Medway Community Healthcare of trying to make itself a social enterprise without consulting its 1,350 staff properly.

Unite believes that such a move would lead to a fragmentation of services provided by health visitors, speech and language therapists, school nurses and nursery nurses for Chatham, Gillingham and Rochester.

The union argues that these moves go against government policy, which is that outside providers can only be asked to tender if a trust is deemed to be failing and has not taken remedial measures.

Sarah Carpenter, Unite’s lead officer for health in the south east region, said: ‘The management is flying in the face of government policy and Unite is now challenging managers to say whether their organisation is failing, as that is the only criteria for bringing in external non-NHS providers.’

Marion Dinwoodie, chief executive of NHS Medway, which includes Medway Community Healthcare, said: ‘In line with national guidance on Transforming Community Services, NHS Medway – along with every other PCT that provides services directly – has been preparing for some time for a future in which commissioning and provision are separate.

‘As part of this, at its public meeting held in September, the board of NHS Medway considered the advantages and disadvantages of different types of organisational structure for Medway Community Healthcare.

‘The board concurred with the view of the commissioning and the providing senior management teams that, on the information currently available, a form of social enterprise, which involves strong links with the community, looks like it is best suited to deliver the high quality care that we want for people in Medway.

‘The board therefore approved Medway Community Healthcare’s right to request the opportunity to explore this further – which means carrying out a planned formal consultation with staff, a full feasibility study and an analysis of risks.

‘The NHS Medway board made it clear that the organisation retains the flexibility to change its preferred model to another one if it appears this would better meet the needs of patients in Medway.

‘You can see that it is absolute nonsense to suggest that Medway Community Healthcare is trying to make itself into a social enterprise without consulting its staff properly.

‘Incidentally, Medway Community Healthcare has invited the unions to a meeting this week to talk about the changes. All have accepted apart from Unite which have currently declined to attend.’

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Two thirds of PCTs still to agree provider model

Posted on October 8, 2009. Filed under: Arm's length providers, Journals, Social enterprise | Tags: |

Health Service Journal | By Steve Ford | 8 October 2009

Two thirds of primary care trust provider arms have not yet had their future form agreed by their board and strategic health authority, a survey suggests.

According to a survey of 83 PCT provider arms, one third said their service model had been agreed by their PCT board and the SHA before 1 October.

This was the original deadline – now dropped – set out in the NHS operating framework for 2008-09 and the government’s Transforming Community Servicesguidance.

Around 40 per cent of providers said they had changed their plans as a result of the removal of the timetable, while the rest indicated that they were significantly advanced in their planning and were not changing pace.

The survey, carried out by the PCT Network, found that most PCT providers welcomed the relaxation of the original deadline for developing their plans.

A minority of respondents were concerned that the move could slow progress.

For example, one respondent said: “We need separation closure – not as an end in its own right – but mainly in order to allow us to move on.

“There is a danger as far as we are concerned in the perpetuation of uncertainty.”

The results of the survey, carried out in September, were announced on Tuesday at the network’s community services conference in London.

Overall most providers said they intended to “stay in house”, (29 per cent), or seek community foundation trust status (28 per cent). Only 4 per cent intended to become a social enterprise scheme.

Where decisions on provider models have been agreed, the preferred option was slightly more in favour of becoming a community foundation trust than remaining as providers within the PCT.

This trend was reversed for provider arms where no formal decision has been made.

The majority of providers, 58 per cent, said their planning had not been affected by the creation of the co-operation and competition panel in January.

Most were also positive about the panel’s impact, saying that it had improved dialogue with commissioners.

However, while the removal of the deadline was intended to allow increased focus on transformational change rather than form, the survey revealed that there was some way to go on commissioning and contestability plans for community services.

More than half, 56 per cent, said their commissioning arm did not have such a plan in place, although many commented that plans were in progress and would be presented to PCT boards before the end of the year.

PCT Network director David Stout said: “The removal of a deadline to agree upon organisational form has allowed providers to focus on transforming the quality and efficiency of services without being fixated on a timetable in which to change their model.

“However, it is important that the momentum for this transformation is not lost,” he added.

Providers were also asked to highlight their top priorities.

Top six priorities:

  • Quality and patient experience
  • Improving productivity and value for money
  • Clinical care pathways
  • Workforce transformation
  • Integration and partnership working with local authorities and primary care
  • Metrics/data and IT
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Newham Primary Care Social Enterprise

Posted on August 5, 2009. Filed under: Press/News Releases, Providers, Social enterprise | Tags: |

Harmoni | Newham PCT | accessed 5 August 2009

The company’s activities will aim to improve the lives of people living in of Newham. There are some areas of Newham which are under-Doctored and have problems accessing primary care physicians. We believe that a Social Enterprise Company, which has at its core 160 GPs in 60 practices covering 265,000 patients, is ideally placed to bid for and deliver primary care services. We will aim to improve access and develop new services that will benefit patients and increase their life expectancy.  We will take an holistic approach to Healthcare. We will work with the PCT Commissioners to initiate a wide range of services to improve health in the community and to ensure that these are easily accessible by patients when they need them. Initially we will bid to provide a combined Urgent care Centre and Polyclinic.


In the future we will broaden our focus to incorporate the management of Long term Conditions in the Community. We will work with other organisations to ensure engagement with social services, the voluntary sector, education, and to improve diet, exercise & health education. This will be focussed on the specific health needs of this diverse, yet integrated community and will deliver focussed care from a company whose GP members are entrenched in the community.


The SEC will be a partnership between Newham GPs and Harmoni, an independent sector Health Care company which specialises in Primary Care. Harmoni was a GP-Co-operative and has in excess of 400 GPs as its shareholders. The GPs will be the majority shareholders of the SEC and will hold 60% of the shares to Harmoni’s 40%. It is axiomatic that all of our services will be free at the point of delivery to patients.


We will adopt an ethical approach to our Health Care business. The combination of local knowledge and National capability will enable the ideas and vision of the local GPs, with their unrivalled knowledge of the community, to be brought to fruition. This will be to the benefit of their patients and the community as a whole. We will ensure that there is considerable patient feedback and involvement in the creation and ongoing delivery of our services. As a SEC we are committed to the benefit of the local community and we understand that we must engage regularly with all elements of the community to ensure that our ethos is maintained. 


Newham Primary Care (NPC) will strive for the highest standards in all that we do. We will re-invest surpluses in the company to ensure that the growth of Newham Primary Care is inextricably linked with an improvement to healthcare services in the community


The board members of NPC are:


Drs Jim Lawrie and Bhupinder Kohli   (NB No links to Jim and Bhupinder as yet)


Steve Turner (Chairman) and Andrew Gardner.


NPC is creating a community board, comprising representatives from a wide variety of Newham’s population. This board will be chaired by Louise Patten and she will report directly to the board, thus ensuring that the board are kept full up to date as to issues in the community.

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Unite warns NHS staff face social enterprise transfer

Posted on July 13, 2009. Filed under: Arm's length providers, News stories, Social enterprise | Tags: |

Healthcare Republic | 13 July 2009

Union Unite/CPHVA is warning that NHS services for children and older people in Bedfordshire face being hived off into a social enterprise.  Unite the Union

Plans to be outlined to staff on Wednesday could see 1,100 staff, and services for more than 100,000 children and 420,000 older people, come under the social enterprise banner.

A letter by Andrew Harrington, chief operating officer of Bedfordshire Community Health Services (BCHS), says: ‘As an NHS staff member working for BCHS you would transfer in to the new organisation under TUPE rules. All of your terms and conditions will transfer, including your pension.’

However, Unite says that TUPE regulations do not protect pensions in this way. Instead staff may not be allowed to stay in the NHS pension scheme and if the social enterprise asks them to take on any new ‘private’ work, they will not be allowed to remain in the NHS scheme. Unite adds that new staff will not be allowed in the NHS scheme.

In a statement to Healthcare Republic, Mr Harrington said: ‘As with PCTs across the country, NHS Bedfordshire is working towards separating its commissioning and provider-arm operations.

‘Under DoH guidance, staff currently working in Bedfordshire Community Health Services are being offered the right to request the establishment of a social enterprise for children and adult services.

‘We are therefore working with our staff, at this very early stage in the process, to gauge their support, views and interest in moving these proposals to the next stage.

‘Staff are being provided with appropriate information to support them in making their own judgement on whether creating a social enterprise is in the best interests of themselves and the services. Plans will only be taken forward with their full support.

‘No decision has yet been made and developing a social enterprise is just one of the options we will be considering.’

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DH to set up social enterprise support framework

Posted on June 23, 2009. Filed under: Journals, Social enterprise |

Health Service Journal | 22 June 2009 | Helen Crump

The Department of Health has launched a procurement drive to set up a framework of organisations to help primary care trust provider arms become social enterprises. DH to set up social enterprise support framework

The department is hoping to recruit a panel of business support providers to offer PCTs “tailored support that is unlikely to be available from within the PCT itself”.

A DH spokeswoman said there was no value for the tender as support would be commissioned by PCTs.

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Transforming health and social care: the Social Enterprise Investment Fund

Posted on June 17, 2009. Filed under: Reports/papers, Social enterprise |

Department of Health | 17 June 2009

This document contains information and guidance about the Department of Health’s Social Enterprise Investment Fund (SEIF) and how the fund supports social enterprises in health and social care.

Download Transforming health and social care: the Social Enterprise Investment Fund (PDF, 1004K)



A fund to transform health and social care

We want health and social care services to be available to everyone on an equal basis. We want them to be locally responsive, high quality and inclusive, especially in areas of social deprivation. This is a mission that lies at the heart of the National Health Service. But achieving our goal is not always easy. It requires creative thinking and new forms of delivery.

So the Government supports the development of social enterprises – innovative service delivery businesses with explicit social aims, whose profits are predominantly ploughed back for the good of the communities they serve.

The £100m Social Enterprise Investment Fund (SEIF) helps this process. The SEIF provides advice as well as seed funding for social enterprises that are starting up. It also offers development loans for established businesses delivering health and social care services.

Funded organisations include charities, community interest groups, and companies limited by guarantee. Funding awarded ranges from research and development costs, through to payment of salaries and to the purchase of equipment and buildings.

The Fund is managed from June 2009 for the Department for Health by Futurebuilders England, working in partnership with Partnerships UK.

What is a Social Enterprise?

 It’s a business with primarily social objectives whose surpluses are principally invested for that purpose in the business or in the community, rather than being driven by the need to maximise profit for shareholders and owners. There are more than 55,000 social enterprises in the UK, with an annual turnover exceeding £27 billion.
What does the Social Enterprise Investment Fund offer?

From June 2009, the SEIF offers:

  •  Loans – they can be used for property, development capital, working capital, bridging finance (until business income starts to flow), to support a merger or to tender for a public service contract.
  • Grants – these can be used to support a new project being set up, for start-up costs, staff costs or other transitional costs. They can also be used for the cost of buildings, vehicles or equipment.
  • Business support – advice on a range of issues: business plans, cashflows, business models, market analysis, marketing, governance and leadership structures, risk analysis, management accounts, client relationships, partnership management, transition management and social return analysis.

If you are already – or wish to start up – a social enterprise delivering innovative improvements to health or social care, you can apply for a loan, grant or business support from the SEIF.

More information about the Social Enterprise Investment Fund can be found at

Social Enterprise Investment Fund

Care to make a difference?

The Social Enterprise Investment Fund (SEIF) provides investment to help new social enterprises start up and existing social enterprises grow and improve their services. We work to support social enterprises in the delivery of innovative health and social care services.

The Fund was set up in 2007 as part of the Government’s plans for stimulating expansion in the role of social enterprise in the provision of health and social care.

By enabling social enterprises to deliver health and social care services, the Social Enterprise Investment Fund aims to improve the quality of services for patients.

Social enterprise

Transforming health and social care: the Social Enterprise Investment Fund


Who can apply?

Social enterprises that can apply to SEIF include:

  1. Multi-agency partnerships, particularly voluntary and community groups wishing to use their expertise to provide services across health and social care
  2. Existing social enterprises looking to expand into health and social care
  3. Groups of professionals, such as nurses or therapists, seeking to form a social enterprise to deliver their services using the ‘right to request’ – see link below
  4. All social enterprises who apply would be expected to have a ‘not for profit’ status.

    Social Enterprise – Making a Difference: a guide to the Right to Request



    Fund managers

    The Social Enterprise Investment Fund is managed on the behalf of the Department for Health by Futurebuilders England, working in partnership with Partnerships UK.

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    GP condemns PCTs for appointing single-faith provider

    Posted on June 15, 2009. Filed under: GP-led health centres, Press/News Releases, Social enterprise |

    Healthcare Republic | 12 June 2009

    A single-faith provider has been selected by two PCTs to provide primary care services, the LMCs conference heard. Polyclinic

    The selection contravenes a fundamental principle of the NHS, it was claimed.

    Staff working for the provider are required to sign up to its values and vision.

    Manchester GP Dr Mohammed Jiva told the conference that Hope Citadel Healthcare, a social enterprise company, one of whose partners is the Salvation Army, has procured two GP-led clinics in Oldham and one GP-led health centre in Middleton, Manchester across two PCTs.

    Hope Citadel‘s website makes it plain that the organisation is a specifically Christian organisation, Dr Jiva said.

    Hope Citadel aims to provide spiritual care and health care ‘alongside and in conjunction with clinical care’, to take into account ‘spiritual aspects’ of wellbeing and to take ‘every opportunity’ for spiritual development, he added.

    Its vision involves ‘working with local churches and other Christian organisations, and developing ways of linking personal and community and spiritual activity with primary care services in order to offer whole-person healthcare,’ he said.

    The person specification for applicants for GP and practice manager vacancies stipulates as an essential criterion support for the vision and values of the organisation.

    ‘The NHS recognises all faiths and beliefs. Yet two PCTs have identified a preferred provider that recognises one belief over all others. This goes against the core principle on which the NHS was founded,’ Dr Jiva said.

    A spokesperson for NHS Heywood, Middleton and Rochdale said: ‘Hope Citadel is a GP-led consortium which was awarded the Health Centre contract at Middleton following a rigorous procurement exercise that was delivered under a national process. The GPs who lead the consortium have provided services in the Middleton area for many years and their bid specifically addressed the varied health issues in that area.’

    ‘The services it will provide will be accessible to all and absolutely not based on faith. Any suggestion that this is the case is inflammatory and without grounds”.

    In a statement emailed to Healthcare Republic, Hope Citadel said: ‘Hope Citadel, a not-for-profit community interest company, is not a discriminatory organisation. We are committed to the vision and values of the NHS and will work with all sections of the community to provide the best whole person care for our patients.

    ‘We currently have a number of community partners who have a christian faith base however, all of these organisations work with and help people of all backgrounds and beliefs. We have been open and transparent in our tender model which included the submission of our own vision and values as part of the assessment.’

    Hope Citadel

    Last accessed Tuesday, 10 February 2009 

    Hope Citadel has been founded by local people who have a local focus on improving healthcare and community care in the Greater Manchester area.

    We are aware of the needs within our communities because we are already working in these community.

    The vision of Hope Citadel has been birthed out of a strongly held passion and desire to see change through the provision of whole person healthcare to individuals and families so that we see lasting change, not just for this generation but successive generations.

    We want to leave a legacy of good health.

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