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Public and private partnerships: A new model for care?

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VOL: 102, ISSUE: 09, PAGE NO: 46

Adrian O'Dowd

The presence of the private sector in the NHS is a fact of life. As primary care is in the throes of reorganisation...

The presence of the private sector in the NHS is a fact of life. As primary care is in the throes of reorganisation, that presence could grow, with new opportunities for alternative service-providers arising. For some companies, that role is already working well, as they are providing services for patients that did not exist before.

ChilversMcCrea Healthcare is a private company that is commissioned by primary care trusts to provide NHS services. It runs 18 general practices for the NHS under a variety of arrangements, with a collective patient list of around 50,000.

Sarah Chilvers, a nurse by background, set up the company in partnership with GP Rory McCrea in 2001, and is clearly the kind of person who is not afraid of trying something new and challenging the status quo. 'One of the themes from my career has been frustration at the way systems are at the moment and always wanting to go out and try to do something differently, both from a patient level and a systems level,' she says.

After qualifying in 1982, Ms Chilvers worked first in care of the elderly. She then took health visitor training, moved into management and then undertook consultancy work, during which time she met up with Dr McCrea and they decided to set up the company.

They then spoke to the Department of Health and asked to be able to provide primary care services because, she says: 'Plurality of provision was already on the cards then - plurality was the buzz word.'

The company eventually won approval as an NHS qualifying body, making it a recognised NHS care provider, and although its staff are not employed by the NHS, their NHS pension scheme is protected and maintained.

'Every practice we have has a clinical lead and a managerial lead, and they report to regional managers who report to me,' she says. 'It means that the clinical lead is as likely to be a nurse as a doctor. The doctors and nurses are treated with equal importance.'

The current discussions to reconfigure primary care organisations, with primary care trusts becoming commissioners more than providers, means the approach taken by ChilversMcCrea could become increasingly popular and could be copied elsewhere.

'I've had three calls just this week from people who are interested in setting up their own organisations,' says Ms Chilvers. 'These were nurses or were calling on behalf of nurses. Community nurses, for example, are starting to realise they might need to start organising themselves to look at how they could be providing the kind of work they do.

'It's definitely not everybody's cup of tea, but people are starting to think about set-ups such as cooperatives, and mutual organisations like the John Lewis Partnership, where you are motivated because you are a partner. I think it's very exciting and there are lots of opportunities for nurses either to fit into something new or to set up something new.'

The transition from the NHS to the private sector is not easy, Ms Chilvers admits: 'I say 'Look before you leap, but do it'. There are risks - financial ones - and people should not underestimate them. To nurses coming out of practice into doing any kind of business venture I'd say: 'Get all the help you can and make the most of your networks and be very aware of the risks'.'

Nurses have just as good a chance of being a clinical lead in one of the company's practices as doctors; in fact, half of these posts are currently held by nurses. We look for the person with the most appropriate clinical leadership skills,' she says. 'We do not have a prejudice for nurses over doctors. It's about teamwork.'

Rather than operating under a triage system, the practices offer patients the choice of who they see. If the case is a more complex one, or deals with a particular specialty, the patient may be passed from a nurse practitioner to the GP, or the other way around.

The company is currently working on a 'menu model' system that provides patients with indications of how to choose the appropriate professional to see.

There have been many benefits for patients under the company's approach, according to Ms Chilvers, who says: 'The practices we have been working in are often hard-to-serve areas, so there can be social deprivation and often, but not always, people have experienced less than wonderful services before we were there.

'It's about bringing services up to what we believe is an acceptable level. A lot of the benefits are getting a reliable and good quality service. Our vision is to start building services up around existing practices so that, for example, patients can go for their diagnostic tests very quickly and get their results quickly.'

The practices are now looking into extending opening hours to make services more accessible, with a possible 8am to 8pm opening time.

Staff also have benefits from working for the company, such as good career development. 'We really encourage people to pursue educational development,' says Ms Chilvers.

There are also regular practice team meetings, which are the forum for all staff to be involved in how services are developed.

Staff being able to keep their NHS pension is important, because, as Ms Chilvers adds: 'I think that makes them still feel a part of the NHS to a certain degree. Yes of course we are a private company, but the feel of the company is very NHS, and like any other practice.'

When asked why there is a need for a service for this kind of company, Ms Chilvers says: 'I'm not sure we are needed, but people want to engage our services because we are looking slightly differently at how the services are provided.

'The education, the teamwork and the fact that you are not isolated and working on your own in difficult areas make it very attractive,' she adds.

In the changing world of primary care, this model is one that is bound to attract a lot more attention.

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