We brought together representatives from government, social investors, thought leaders such as the Nuffield Trust, and primary care providers themselves. It is clear that the ambitious transformation agenda facing the primary care sector is dependent on finding new sources of capital – our discussions explored how social investment might play a role.
The big trends in primary care include consolidation and federation, with most of the growth being driven by CCG encouragement. The opportunity for consolidation is accompanied by ongoing challenges within the sector, with a particular focus on sustainability. One of the primary care providers cited having their funding source changed five times in six years: these constant upheavals are representative of the industry and create significant volatility and uncertainty within the landscape. Additionally, the ongoing health transformation reforms have the potential to disrupt even the most well thought-through business plans.
These new consolidated structures are focusing on extending services and developing organisational strategies (see recent survey by Nuffield trust ). However the discussion revealed that the level of investment from CCGs to undertake these changes can be very varied, with some areas reporting very little support. Other sources of investment are paramount.
Having a social ethos and a structure to support this is increasingly helpful in engaging with commissioner discussions, and playing a role in system transformation. The recent survey by Nuffield Trust shows that about a tenth of GPs are either CICs, Co-ops or other forms of social enterprise.
So, what could social investment offer primary care providers in this context?
- Firstly, for many, there is a need for growth capital to expand patient lists through mergers or acquisitions, diversify income or improve organisational capacity. Growth for primary care providers is not growth for growths sake: many around the table believed that by achieving scale, they would be able to increase efficiency and deliver greater impact. Nevertheless measuring and isolating the impact of structural changes on patient outcomes is particularly difficult and will be a consideration for social investors looking to get into this space.
- There is also a need for support for bidding for upcoming contracts. Similar to much of the health sector, contracts being issued often do not create a level playing field for smaller, social sector providers and therefore the backing of a social sector
- Lastly, it is clear that these investments will need to focus on infrastructure; as practices expand or upgrade their systems and buildings, the supporting technology and property will be crucial.
Most importantly, there was a strong sense that commercial investors do not understand the health sector and are not as willing to go on the same collaborative journey as social investors might be. Providers want an investor to act as a partner in their development, and to understand what they’re looking to achieve for their population, rather than simply fill a financial need.
It’s clear this topic deserves further exploration: we only managed to scratch the surface in terms of the risks and challenges faced by new and evolving primary care enterprises. But it was apparent, especially in the context of the GP Forward View published this month by NHS England, that there is a real role for social investment in supporting and underpinning the development of primary care provision.
Now more than ever, it is time for these two “worlds” to come together in order to deliver on the ambitious plans ahead.
If you’re interested in being involved in further discussions, do let us know by contacting Daria Kuznetsova at Big Society Capital or Clodagh Warde and Rosanna Hardwick at the Care and Wellbeing Fund.