Social Enterprises and the NHS - Unison

Appendix three
Examples of social enterprises in primary and
community care
1 Social enterprises led by nurses and other
community-based staff
Examples, including those under development at the
time of writing, include:
• Central Surrey Health Perhaps the most prominent
and controversial example of social enterprise led by
community staff is Central Surrey Health which
emerged from the former East Elmbridge and Mid
Surrey PCT and encompasses nurse and therapy
staff. It is a private not-for-profit limited liability
company, described as supported by almost 800
nurses and therapists, and the first large-scale
transfer of key services to an employee-owned
organisation within the NHS. It is a company limited
by shares and has been organised through SPMS;
some argue that for this reason, it is not strictly a
social enterprise. CSH has a £22 million contract to
supply speech and occupational therapy services to
stroke victims, those suffering back pain and people
with disabilities. Non Executive Directors are mainly
non clinicians. NHS terms and conditions are used as
standard, and employees continue to be eligible for
the NHS pension scheme. Contract length is a
minimum of three years. Joint Trades Unions drew
attention to failures in management, unclear
management structures, poor contractual and
financial planning and a lack of clarity from the PCT
about the services it wanted CSH to provide and at
what cost. Staff were concerned about the pensions
issue and security of staff employment. Private
companies complained, however, that it was unfair
that services provided by CSH were not put out to
tender.
• Cuckoo Lane Health Care, Hanwell, West London:
This social enterprise won an APMS contract from
Ealing PCT. It has three nurse directors, was set up in
conjunction with ECT, an environmental social
enterprise (www.ectgroup.co.uk), which pioneered
kerbside recycling. It provided financial and
infrastructure support for Cuckoo Lane. There are two
salaried GPs.
• Surrey Heath and Woking: A group of nurses
planned to set up a Community Interest Company
reflecting principles of mutuality, to provide nursing
services within the catchment of the former Surrey
Heath and Woking PCT. This would enable local
partnerships to be retained. It also planned to run the
local community hospital if the contract was won from
the PCT. All staff and would be members in the
company, as would representatives of patients and
local stakeholders.
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• A nurse-led social enterprise for people with multiple
sclerosis operating via a phone helpline and tele
health system for monitoring patients is under
discussion
2 Social enterprises developed from out-of-hours
care and practice-based commissioning
• South East London Doctors Cooperative (SELDOC)
(www.seldoc.co.uk) refers to 500 local GPs in a limited
company, set up in 1996. It is owned, managed and
financed by GPs and now represents 90 per cent of
GPs in the boroughs of Lambeth, Lewisham and
Southwark. This is a members cooperative (owned by
members with surpluses reinvested in the community).
It is largely, though not exclusively, an out-of-hours
service. There is a Council, and Board of Directors.
• Local Care Direct, established in 2004, is one of the
largest providers of out-of-hours services in the
country, with a turnover of £17.5 million, and is a
community mutual benefit society serving over 2
million people in West Yorkshire. Services include
dental services, night caring services, out-of-hours
cover for prisons, on call pharmacy and palliative care
in addition to standard out-of-hours care. There is a
Governance Board, with four executive and five non
executive directors; an Advisory Council; and anyone
over 16 can become a member and attend Annual
General Meetings.
• East London Integrated Care (ELIC): ELIC was set
up as a non profit making mutual company (an
industrial and provident society) in July 2006. It is an
umbrella organisation for practice-based
commissioning for 37 of the 49 practices in Hackney.
It is hoped to provide a range of services, aimed at
reducing hospital referrals and rates of admission,
develop new clinical pathways to speed up patient
care, improve access and quality and generate
savings that can be reinvested in capacity building
and modernisation. There are plans to extend to
Newham and Tower Hamlets. It is not adopting a
cooperative or CIC route but a form of Industrial and
Provident Society called a ‘A Society for the Benefit of
the Community’. It has begun by offering communitybased
ear, nose and throat services for patients from
across the City of London and Hackney. There has
been extensive media coverage via the King’s Fund
and others. Its aims are to protect NHS services from
being ‘picked off’ by the independent sector.
At the time of writing, companies or consortia formed by
doctors to target APMS contracts were being considered
in Leeds (LeeDrs, across 19 practices); Staffordshire (50
GPs), North Tyneside, and Doncaster. Commissioning
consortia are widespread. Other schemes were being
developed to provide community hospital services under
a social enterprise model.