Written evidence from Assura Medical Limited
(COM 61)
ASSURA MEDICAL
Assura Medical, now majority owned by Virgin,
aims to improve health outcomes for patients by enabling a greater
range of services to be delivered in primary care and community
settings. We achieve this by partnering with groups of GPs to
develop provider companies (GPCos). We have now formed 30 GPCos
with GPs representing over three million patients and these are
now providing a wide range of services including diagnostics and
out-patient day care services, GP surgeries, walk-in and urgent
care centres. As well as providing convenient high quality services
for patients, our services have also generated significant savings
for PCTs.
Our GPCos work closely with a wide range of
providers from across the NHS, social care and independent sectors.
We have formed a range of innovative models to provide integrated
services that span primary and secondary care which we see as
essential to develop joined up and cost effective services.
SUMMARY
— Assura Medical welcomes the proposals
set out in the NHS White Paper and believes that they represent
an opportunity to drive real change within the service. Many of
the proposals reflect Assura Medical's approach of working with
GPs and we are therefore pleased that the White Paper reflects
the critical role clinical groups play within the NHS. The Assura
Medical business model fully supports choice of provider for patients
and bringing services closer to home. We wholeheartedly believe
that these measures improve quality, patient satisfaction and
value for money.
— To deliver the vision laid out in the
White Paper, a plural market will need to be established which
meets agreed quality standards and works in innovative combinations.
This will require providers to emerge that can understand and
bear operational risk through delivery mechanisms such as the
"prime contractor" model, helping unlock savings and
changing traditional behaviour. A failure to stimulate the market
and encourage new providers will make it difficult for GP commissioners
to drive through reform and will result in reduced patient choice
and reduced access to quality services. We believe that Assura
Medical and other large-scale providers have a very important
role to play in making these reforms a reality, challenging the
monopolistic control traditional NHS organisations have exerted
until now.
— Any Willing Provider sits at the heart
of this and must be mandated immediately. A historic problem is
that despite it being policy AWP has not been implemented, frustrating
reform and locking innovative providers out of the system. A level
playing field must be ensured and difficult hurdles such as NHS
pensions overcome for these reforms to realise their potential.
1. Opening up the system to new entrants
1.1 Assura Medical believes that the Government's
vision will not be achieved unless there is comprehensive implementation
of Any Willing Provider.
1.2 Any Willing Provider needs to be centrally
mandated and implemented urgently. Assura Medical's experience
is that interpretation of the current regulations enables it to
be left to local determination. This has led to it being very
difficult for new entrants to provide services. This is the reason
that patients still do not have meaningful service choices in
most areas of the country and we are concerned that this situation
will be perpetuated unless Any Willing Provider is swiftly and
consistently directed from the centre. Above all things, it is
this one issue that will determine how quickly we see substantial
private sector investment in healthcare as well as transformed
outcomes for patients.
1.3 If Any Willing Provider is fully implemented
throughout the country then the provider market will flourish.
1.4 We believe that the full implementation
of Any Willing Provider, and the associated sharpening of market
principles, can be done where appropriate in cooperation with
the NHS or any other provider within the clinical community. Competition
drives innovative collaboration and new providers bring innovation
and challenge to the existing system which is currently not sufficiently
responsive to consistently meet patient need. The incentive within
the system to achieve this will sit with a better informed patient
able to determine their own care pathway and constantly challenging
commissioners and providers over the service they are receiving.
1.5 Monitor's role in overseeing both competition
and cooperation will be critical and for the sake of clarity we
believe its role should be statutorily defined within the Health
Bill.
1.6 Assura Medical believes that it will
be important to allow for local tariff setting as a way of responding
to market pressures. Assuming that Any Willing Provider is universally
applied then it will be possible to introduce local tariff setting
based on the market response.
1.7 Assura Medical welcomes the information
revolution that the White Paper suggests will be forthcoming and
believes it to be integral to the reform agenda. We firmly believe
in providing patients with quality information from which they
can make an educated decision about which provider best meets
their needs. Assura Medical is committed to being transparent
with the public so patients can understand what our services can
offer them and how they differentiate between us and our competitor
organisations. The quality indicators being worked up by the Department
of Health will be crucial in delivering this and in ensuring that
patients can straightforwardly evaluate the different services
on offer to them.
2. Effective commissioning
2.1 Assura Medical takes no view on the
size and scale of commissioning consortia since we agree with
the Department of Health that this should be left to local determination.
In essence however good commissioning is about securing better
value for patients from the available resources. If GP Consortia
are the organisations with responsibility for delivering this,
three key things need to exist to achieve best outcomes:
(i) clarity about the outcomes to be achieved;
(ii) meaningful information for patients which
tells them about the things they care about; and
(iii) competing providers incentivised to provide
informed patients with the services and experiences they want
which meet the outcomes required by the commissioners.
2.2 It is our belief that the combination
of informed patients and competing providers will enable GP Commissioning
Consortia to achieve the required outcomes for their patients
for the best value. The history of healthcare and other industries
indicates that it is providers and suppliers which drive innovation
in service delivery in response to clear outcomes and informed
consumers.
2.3 We would urge the Department of Health
to be clear with GP Consortia that their role in securing the
best for patients is to define what outcomes need to be delivered
and NOT restricting the market from delivering these outcomes.
The commissioners' role is to define what is required at a high
level, not who provides it or how it is provided.
3. Regulation
3.1 The consultation documents that accompanied
the White Paper went some way to detailing the manner in which
providers will be regulated and accredited by the CQC and Monitor
but further work will be required for this important element of
the new system.
3.2 Assura Medical endorses the division
of responsibility between the two regulators though would urge
both Monitor and CQC to develop an overlapping approach which
reflects the emerging provider market. We think it important that
the regulators do not erect unnecessary barriers to market entry
by making the accreditation process unnecessarily cumbersome and
bureaucratic.
3.3 Monitor's role will be particularly
important, especially their responsibility in managing the market
and ensuring a fair playing field for health service providers.
Assura Medical believes strongly that Monitor's role in overseeing
the market should be embedded in primary legislation so as to
make clear what it is—and is not—responsible for regulating.
October 2010
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