Client: Sussex Community NHS Foundation Trust
Date: April 2018 – February 2019
Challenges faced by the client: Across the UK, primary care is under ever-increasing pressure, with activity on the rise, growing patient expectation of rapid access to GPs, reduced funding and insufficient workforce. These issues are further compounded at a local level by a fragmented delivery model, within which independent GP Practices of varying sizes provide the entry point into the NHS, often in isolation from all other services.
Due to the nature of existing structures, the Trust concluded that it was not well positioned to provide an integrated suite of health services to address these challenges. Financial risk, an inability to access economies of scale and reduced leverage to drive collaboration meant that primary care resilience and provision would decline if change did not occur. These circumstances were having an increasingly negative impact on the Trust and putting its long-term sustainability at risk.
For the Trust, ‘doing nothing’ was not an option - it was required to explore new ways of delivering community and primary care services. The Trust concluded that a new model and system was required to facilitate the redesigning of care around the health of the local population, without being restricted by existing institutional arrangements and systems. The model was required to focus on creating a new system of care delivery, backed up by a new and sustainable business model aligned to the Trust’s Communities of Practice strategy.
Support offered: Mutual Ventures led a delivery team during three separate stages - (i) an options appraisal to build the case for change and identify the preferred delivery model and legal form for the new model; (ii) the development of a full business case to assess the strategic, economic, commercial, financial and management cases associated with the establishment of the proposition; and (iii) the implementation of the new model, including the development of a Target Operating Model (TOM) for the Special Purpose Vehicle (SPV), ‘Sussex Primary Care’.
Working directly with the Executive Board, Deputy Director of Development and Partnerships and Commercial Development Manager, we ensured a collaborative approach, ensuring the identification of a preferred delivery model that met the requirements of all key stakeholders, while being open about the technical issues that required consideration/resolution and the cost/risk involved.
We drafted the full business case for Trust Board approval, using the five case model. Developing a robust, objective and fully costed analysis that demonstrated how the proposition would enable the Trust’s primary care strategy to be implemented. Work was undertaken to ensure that all commercial and governance arrangements were identified and considered to enable the system to deliver its intended function, leading to the development of a prudent financial model and feasible implementation plan. Benefits (financial and non-financial) were identified, in addition to the legal and contractual issues that formed the basis of the Trust’s relationship with the new model and the integration of GP Practices into the model.
Finally, following Trust Board approval, we supported the Trust into implementation phase. This included creation of a TOM for Sussex Primary Care, creating the framework for the integration and running of GP Practices under the new organisation.
Outcome achieved: Our support resulted in the creation of a SPV, in the form of a Company Limited by Shares (wholly owned by the Trust), for the purposes of integrating primary and community care. Sussex Primary Care has begun integrating GP Practices, with more planned.
We helped the Trust design and implement a innovate solution to the pressures facing the NHS, especially primary care. If realised, the financial projections that inform the business case identify a financial net benefit to the Trust of c£4.8m over 10 years, as well as offering significant potential for system improvements and the realisation of positive impact on the quality and co-ordination of care.
‘’What a great team. I genuinely believe MV's behaviour deserves recognition and their impact has been amazing. The clear way MV presented the processes helped the team get up to speed quickly. Their tremendous contribution to our business case demonstrated real next-level skill’’
Carol Boyd-Jones, Commercial Development Manager, Sussex Community NHS Foundation Trust