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  • Writer's pictureAndrew Laird

A new model for smaller providers to deliver at scale

Updated: Apr 6, 2021

Writing for Public Sector Executive, ahead of the Health + Care conference,  MV’s Andrew Laird explains an exciting new model for health and social care collaboration.

There is little doubt that devolution will be the chief driver of public service reform for the remainder of this parliament. Local leaders across the country are enthusiastically negotiating tailored devolution deals as a means to bring decisions about public spending closer to themselves and the public they represent.  Very much allied to the devolution agenda is the concept of integration which describes a more joined-up approach to service delivery and is most conspicuous in plans for the future of health and social care.

However, the government’s ambitious plans for integrating health and social care describe a market that doesn’t fully exist yet. The service offerings, commissioning structures, and relationships needed to support integrated health and social care are very different to what we have at present.

Many commissioners are arriving at the conclusion that the only safe option is to commission larger organisations to act as the prime contractor/provider and leave it to them to engage with smaller organisations to provide specialisms and local knowledge.

This creates a problem for the many smaller social enterprises and charities who play such a critical role in the health and social care marketplace. The prime provider model did not work particularly well in the Work Programme. Many smaller providers felt that once the contract was secured they were squeezed out of the delivery and the associated payments on which many of them were reliant.

Let me be clear that this is not plea for charity on behalf of smaller providers. Whilst commissioners could and should be playing a more proactive market shaping role, smaller providers also have to be pro-active and take charge of their own destiny.  Let’s consider commissioners first.

Commissioners cannot allow their role to be limited to understanding local needs, specifying service contracts and appointing providers. They must embrace the role of “market-shaper” if ambitions for integrated health and social care are to become a reality.  This can only work if CCGs and social care commissioners invest time in building a good working relationship with each other. Generally speaking, this is not working as well as it could or should. Working together the commissioners must ensure they understand the whole provider environment in their local area, which includes the smaller social enterprises and charities, and seek to create an environment which encourages collaboration. It’s definitely easier to just seek out a prime provider and leave the rest up to them – but this hands off approach may not give commissioners the outcomes they are looking for.

So what about the smaller providers – what can they be doing to show commissioners they are up to the task of delivering services in a devolved and integrated environment?

Mutual Ventures have been working with eight health and social care focused social enterprises and charities in the north of England. They have joined forces to form a new Limited Liability Partnership (LLP), the Health and Well-being Partnership. Through this they are offering commissioners a single legal entity through which they can provide entire service pathways across a wide geographic area. The model allows the members to compete against larger providers but also retain their organisational independence and continue to deliver services on their own. Whilst there is joint ownership, it allows the members to be involved in delivery to differing degrees depending on the service or group of services in question. The joint ownership model also removes any unwanted perverse incentives (like holding onto patients for longer than necessary) that often exist along the service user pathways in a traditional prime provider arrangement. Its early days for this model but the response so far from commissioners has been very positive.

The big win for the LLP members is it gives them a chance to bid for opportunities that they would normally be excluded from due to their small individual size.  However, this should be incredibly attractive for commissioners as it opens up the provider market and provides an alternatives to the classic prime provider model.


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