In August 2017, the four practices agreed to join to form a single organization, Health & Beyond. This new organisation has 13,000 patients and 5 partners. In the context of a potential increase in competition and increasing pressure on resources in Primary Care, the decision to merge was an easy one. The decision essentially boiled down to a choice between collaboration and competition. We believe our new organisation will be stronger than the sum of its parts.
We hope to be more resilient as a business, making it easier to maintain quality care for our patients in the challenging the years to come. Patients will have more choice and more services provided in the Primary Care setting this provides the opportunity not only to merge, but also to restructure our organisations.
We have always mutual trust and respect which has helped us keep things moving along, this is especially important when things are less straightforward. We all feel we are working with colleagues who share the same work ethos and values. We value quality care for our patients, encourage staff development, education and are now developing a sound business structure to underpin our vision while looking towards measured growth to reinforcement this vision.
The expanding GP partnership and the role of Health and Beyond Ltd: The Health and Beyond GP super-partnership will begin with the merger of three practices with 13,000 patients in November 2017 .It will soon expand in April 2018 by merger of three more practices taking the total number of patients to 25,000.
We expect to further consolidate this number by merging with one more GMS practice and service provider arrangement with an APMS practice taking the total number of patients served by the partnership to about 40,000.
This rapidly expanding Super partnership will need a shared service and multiple back office and logistics service provider.
Health and Beyond Ltd (a company Ltd by shares) will deliver this functionality for the Super partnership. This paper describes the rationale and the importance of developing a service provider company to support the growing General practice partnership.
A key challenge has been the change in mindset for partners and staff alike, to begin to think like a single larger organisation. The HR processes require a lot of time, and attention to detail.
Protected time is essential to be able to work through these issues. We also used small working groups with representation from all member organisations to maintain engagement, and as a vehicle to share work with the wider partnership.
Our patients have largely embraced the idea of our merger, we have focused on communicating the benefits to the service they will experience, and we plan to engage our practice population more closely to help us plan for the future. Our merger took place in November 2017, however there is still work in progress, we are learning every day!
ANALYSIS OF THE SITUATION UK
There has been increased demand for primary care but the percentage of the NHS budget spent on general practice has decreased from 11% in 2006 to less than 8.5% at the moment, in fact, in 2014/15, the percentage was 7.94% (the lowest in 10 years) and this will only decrease further in the next three years further forcing GP’s to close. Despite this, the government are asking for more; with an aim to move hospital care into the community without supplying the resources for this to be made possible.
The government would like GP Surgeries to be open 12 hours a day and seven days a week to keep up with this demand but there aren’t enough resources or enough GP’s. There are now 7,962 GP practices in England, meaning that one in 20 has disappeared since 2010.
While some closures may have resulted from surgeries joining together, which can bring numerous benefits to patients, there is no doubt the catastrophic impact of funding cuts and decreasing resources is a contributing factor, unless mergers become a thing of the future at health care within primary and community care levels.
We believe development of Health and Beyond Ltd as the HUB of service provision delivering services for the GP partnership is in line with the long-term vision of developing and delivering a Health care Ecosystem detailed further in the vision statement.
Decision making Partners have recognised that upon inception the partnership will work in a different way to existing organisations not least because it will be a multi-million pound organisation. Trading initially would be circa £1.2m turnover but with the opportunities to grow both as Primary Care Provider and as social care co-ordinator of services. Therefore Health and Beyond Ltd has been developed as a service provider company which will support and develop the shared services portfolio for the partnership.
Health and Beyond Ltd will be essential to coordinate, rationalise and streamline back office services I.e. -financial services, business intelligence, and compliance and Assurance aspects of delivery of care. Significant investment has been made in professional support and systems to enable this to happen so that initial projected savings are made, and organisation development programmes remain on track.
There will be a need to refocus to provide local delivery centre on site supervision and accountability together with centralised core support for the new partnership (such as CQC, HR, IGSoC, finance). Clinical services will need overhaul and upgrading to deliver peripatetic local services and greater access to extended hours’ services. The Health and Beyond Ltd will take on the role of co-ordinating these services and developing compliance systems for the Partnership.
Service development and clinical governance specialism’s will be delivered at core support and local level to enable this to happen. It is clear therefore that a conventional partnership model of decision making could be considered somewhat outmoded if put in place here. A large committee of partners deciding on every day operational matters would not be a good route to, decision making in a dynamic multi million pound environment with significant service redesign and back office consolidation opportunities. Health and Beyond Ltd Executive board will eventually take on the decision making role for the growing partnership and its partner organisations while they would deliver the services. Health and Beyond Ltd will support and co-ordinate these services.
We have therefore developed an Executive Board of Directors who will be responsible for different portfolios within the new organisation. The Directors and their roles and responsibilities are detailed below.