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GP-run provider turns to private firm

Dr Tim Kimber on what happened when his GP-owned company struggled to gain PCT contracts.

When I last wrote in GP about Innovations in Primary Care Ltd (IPC), a GP-owned company based in West Sussex, I said that we had reached a critical point and needed to build on our early success.

That was last July. A lot has happened since then, culminating in IPC's shareholders voting to operate in tandem with a private-sector healthcare company.

'Do or die' time
Our shareholders are all the GP practices in a well-defined geographical area (Worthing and its environs) covering a population of about 300,000. I am one of IPC's directors.

IPC went live in the spring of 2006. But by last summer, and despite being successful with a couple of early bids to undertake services, the bureaucratic nightmare of five local PCTs merging had halted progress. It was beginning to look like 'do or die' time.

IPC was set up to protect practices against the threat of private companies moving into the local primary care market and to seize opportunities to move clinical work from the acute sector into the community.

But, by last summer, there were major obstacles. One was that the newly-formed West Sussex PCT was unwilling to risk committing large-volume community contracts to a provider without a track record. Also, because IPC's directors are all GPs with day jobs, our IPC workload was becoming onerous and, in some respects, beyond our expertise.

We realised IPC needed a 'partner' - a word I use advisedly. There are many companies wooing GP groups so that they can gain a foothold in primary care, but few can be described as potential equal partners.

Ashley House Clinical Services (AHCS), however, was different. Part of a group of businesses in the health and social care sector, it offers to partner GP provider groups. IPC's directors spent the latter part of 2007 talking to the company as to how best to work together, given that it is a commercial enterprise and IPC has never intended to make large-scale profits.

AHCS's approach was refreshing. The company agreed that to make any joint business profitable, excellent services for patients has to be the number one goal - and that clinicians must control clinical services.

Equal stakes
IPC's directors worried that our shareholders would object to inviting in a private-sector company. However, at an extraordinary general meeting in December, they voted almost unanimously in favour of a joint venture company with AHCS.

AHCS, which provides corporate, financial and management support, and IPC each have a 50 per cent stake in the new company IPC Plus Ltd. However, IPC will hold all provider contracts gained by IPC Plus.

One reason is that IPC (but not IPC Plus) can hold specialist provider medical services contracts, enabling its employees to benefit from the NHS Pension Scheme.

Another is that, because no AHCS director or employee sits on IPC's board, IPC retains the final say on the details of provider contracts. IPC Plus currently has a shadow board. IPC and AHCS have been working with our legal teams on IPC Plus's formal documentation.

We have made a good start on producing business cases for the services we wish to provide (see box). Also, our PCT covers 770,000 patients, and discussions with another GP provider group in West Sussex, with a view to combining forces are well advanced. Other GP groups in the county are interested. By the end of 2008, we hope that every GP practice in West Sussex will be an IPC Ltd shareholder.

Initially the PCT reacted cautiously to IPC Plus. But there are signs that it sees a GP provider group as the potential answer to a lot of problems, particularly if we go countywide.

We are confident of success in winning contracts including any for running and building 'Darzi' polyclinics. IPC Plus has had several encouraging meetings with key PCT personnel. The future for IPC looks a lot brighter.

Dr Kimber is a GP in Littlehampton and is West Sussex LMC deputy chairman

Joint venture
  • GP-owned Innovations in Primary Care Ltd (IPC) based in Worthing, West Sussex has set up a joint venture, IPC Plus Ltd with Ashley House Clinical Services (AHCS).
  • Under the (original) IPC shareholder agreement, the GP practices bought a £1 share per 100 patients. They also lent IPC capital for start-up/running costs.
  • IPC bids for and holds contracts chiefly to run community clinical services moving from secondary care.
  • IPC and AHCS each own a 50 per cent stake in IPC Plus. AH provides back office functions and, by matching IPC Ltd shareholders' loan capital, financial support.
  • IPC Plus is writing business plans to run countywide community dermatology, an intermediate clinical assessment and triage (ICAT) service for most outpatient services, community neurology and sexual health services.

Ashley house

  • AHCS is owned by Ashley House plc which was set up as a GP premises developer in 1991. Its subsidiaries also include AH Medical Properties plc for GP premises lease schemes and Ashley Novoe, a social enterprise to enable/support organisations in health/social care community ventures.
  • www.ashleyhouseplc.com.

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