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Grow your own

Grow your own

Insight: GP Care
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Helen Northall
Chief Executive, PCC

A clinician-owned provider of healthcare services is responding to what it sees as an inevitable 'big is beautiful' approach to commissioning in the new NHS.

GP Care was formed in Bristol in 2005 and has 100 of the area's 105 GP practices as shareholders. It holds seven NHS contracts secured on the basis of moving the relevant services from the hospital to the community. This work is then sub-contracted to GP practices with appropriate expertise and qualifications, the district nursing community interest company and to other local NHS organisations – including local NHS acute trusts whose specialists are contracted to work in the community.

Addressing PCC's recent Working in Partnership conference, the limited company's chair, Dr Phil Yates, was blunt about the thinking behind the company's formation.

"In bringing services into the community we are now in a situation of competition," he said. "Capita and PricewaterhouseCoopers are interested in this market. The NHS is the commissioner and providers will increasingly be a mix of independent, large competitors. We felt in Bristol that independent and small partners such as practices are not going to get a look in at winning contracts because commissioning organisations would not want to contract with 50 smaller practices or partners.

"Therefore, we thought we needed to set up GP Care to hold the contracts for services in the community and ensure they were provided where patients need them."

The company is profit-making and the share price has risen 70% but Dr Yates insists that it is driven by NHS values, no shares have been sold, it always prices services below the NHS tariff and shares profits with its sub-contractors to reinvest in service improvement.

He says that by using local clinicians – including hospital specialists working in community settings – the company is helping to ensure that specialist knowledge and expertise is not lost to the area. The model, he says, is aimed at preventing the cherry-picking of services by private organisations.

Having secured £400,000 initial investment from the shareholding practices in 2005, Dr Yates says the company initially struggled to "drive over the line" in winning contracts. The company had to return to shareholders for another £400,000 so it could appoint a commercially savvy chief executive and put in place the structures to start winning contracts.

It had a £1.7m turnover in 2010/11.

Dr Yates insists the company only bids for contracts where it can improve the patient pathway with community-based services that benefit both the patient and the taxpayer.
As evidence, he points to the company's delivery of a new deep vein thrombosis service.

Under the new model, patients average 4.7 visits to a local base compared to 8.4 hospital visits previously. The price for the commissioner is 72% lower than under the old model.

Dr Yates acknowledges fears voiced by commissioners and commentators alike of a conflict of interest for GPs having a financial interest in organisations they are referring patients to, but he voices frustration at what he sees as a public-sector blind spot.

"Everyone has a potential conflict of interest, whether you are talking about big companies or acute trusts or GPs. Yet this fear is stopping commissioners from talking to potential providers about ideas for improving services and using those contributions to shape service specifications. That is what would happen in the private sector."

GP Care, he says, seeks to ameliorate such concerns by requiring all GPs to inform patients at the point of referral to a GP Care service that they have a stake in it.

That stake, Dr Yates insists, needs to be kept in proportion however. "We have discussed this with the primary care trust and we think each referral typically earns the GP 2.5p."

In any case, the model is not alone in drawing concern around the appearance of conflict of interest as the commissioning reforms continue their progress through Parliament and to full implementation.

Meanwhile, GP Care continues to position itself – and local GP practices – to take on the big boys in the new market.

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