Super-partnership seeks to think big while acting local

8 May 2017

For organisations looking to grow, delivering services at scale while retaining local autonomy and a distinctive feel has always been a challenge.

Dr Mark Newbold says Birmingham-based super-partnership Our Health Partnership (OHP) is managing to achieve just that. It is providing primary care at scale – its combined patient list of 280,000 makes it bigger than many clinical commissioning groups – while maintaining the independence of its 35 practices. Nine more practices will join in May,taking the list size to 370,000.
 
Newbold, a former acute trust chief executive, has been part-time managing director since OHP’s launch in November 2015 when the 35 practices dissolved their partnerships and formed a single new partnership, OHP – with each retaining their GMS or PMS contracts.
 
He works with two other executive directors, each with an NHS background. They are on the OHP board, sitting alongside seven elected GP managing directors, a balance Newbold says ensures the organisation remains GP-led.
 
“The organisation is run by a board but we do not dictate to practices. We agreed with commissioners that practices would keep their individual NHS contracts. That was not just to protect individual practices’ profits but to ensure that they could make decisions on things that do not affect any of the other practices – for instance staffing levels or opening hours.”
 
Talking at PCC’s recent Going with the Grain event, Newbold said: “We have a single board with a single purpose but not a single way of doing things. The word practice is no longer synonymous with partnership but this is still a partnership and not a corporation.”
 
This ethos is enshrined in the partnership deed.
With some 680 practice staff transferring under TUPE to the new super-partnership and an annual income of more than £40million, Newbold recognises that some might suggest his organisation is too big for general practice.
 
“Are we too big? I would say no because we do not manage our practices: we support our practices to manage themselves. We avoid being centrally driven as the NHS has had enough of that. Coming from the acute sector where trusts run on a corporate model we know that you need accountability at the front line. In general practice you have that and it is very important you do not lose it.”
The seven GP board members were elected by the partners after each submitted a 300 word manifesto.
“The GPs on the board are firsts amongst equals. They are there as leaders rather than managers. You don’t need management expertise to be on the board because they hired that in.
“Working as a board member is completely different to taking part in a practice team meeting as you are spending resources that are not yours.”
The important thing, he said, is for the board to communicate effectively with its GP members and to prioritise that representative role. It does this partly through regular partners’ meetings and locality gathering but Newbold admits that the organisation needs to continually think about how it reaches and informs busy GPs.
OHP achieves efficiencies by delivering functions such as finance and payroll centrally. Savings on accounting costs alone ensure that practices recoup almost half the £2 a patient subscription fee, Newbold says.
Among the other benefits of membership are OHP’s banks of locums and other healthcare professionals, central procurement, monthly payroll services and benchmarking reports.
The latter will be accompanied by regular dashboard reports that have taken on new significance now that OHP is to be registered as a provider with the Care Quality Commission effectively replacing individual practice registrations.
Newbold says: “We sit between the practices and the CQC. The practices will now be registered locations that we monitor. That means they will not be directly inspected as often, and we can generate an ethos of quality improvement through peer advice and support.”
Equally important, Newbold suggests, is the visible presence and voice that the super-partnership has belatedly given GPs in the development of sustainability and transformation plans (STP).
“We have been pretty successful in getting GP representation in the STP process even if it was fairly late in the day. We banded together with other GP provider organisations to give a single general practice voice. It’s been helpful in terms of visibility even if we’re not yet influencing output.”
However, perhaps more importantly, the structure also increases the scope for local primary care providers to deliver new services – including through eventually evolving into some form of multispecialty community provider (MCP). The super-partnership’s central team is charged with growing the organisation by bidding for new contracts.
Newbold says there is an opportunity for the organisation to commission its own out-of-hospital services.
Early thinking around the possible MCP development includes discussion around a separate vehicle involving community, acute and mental health partners. First steps towards that goal could include ‘wrapping’ services such as physiotherapy and district nursing around practices.
However, Newbold insists that the partnership will remain intact and continue to be based on the GMS contract.
He says: “OHP demonstrates that independent general practice is viable, sustainable and able to contribute effectively to delivering the modern NHS. The partnership model of GP practices can deliver the transformation agenda.”
PCC can advise on all aspects of collaboration in general practice, from agreeing a shared mission to working through the legal detail and writing a business plan.
For information about PCC’s support for primary care development, contact enquiries@pcc-cic.org.uk
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