1. Langbaurgh Social Enterprise – A Case Study Ian Reeve Managing Director

2. A Bit About Langbaurgh Social Enterprise Serves a population of 97,000 in Redcar, East Cleveland and Guisborough Serves a population of 97,000 in Redcar, East Cleveland and Guisborough A history of working between practices A history of working between practices Made up of and governed by a Stakeholder Board made up of 15 General Practices with 2 patient reps Made up of and governed by a Stakeholder Board made up of 15 General Practices with 2 patient reps Four Directors – appointed by a Stakeholder Board Four Directors – appointed by a Stakeholder Board

3. What is Langbaurgh Social Enterprise? Company Limited by Guarantee from Oct 2007 Company Limited by Guarantee from Oct 2007 Directors, Memorandum of Agreement and Articles of association Directors, Memorandum of Agreement and Articles of association Legal entity - can own assets, borrow, employ staff and is subject to companies regulation, tax regime and can form joint ventures with other entities Legal entity - can own assets, borrow, employ staff and is subject to companies regulation, tax regime and can form joint ventures with other entities

4. The Three Core Elements of a Social Enterprise Community Membership - a membership of 15 general practices Community Membership - a membership of 15 general practices For Benefit of the Community - purpose is to improve the health of the local population, particularly through primary care services For Benefit of the Community - purpose is to improve the health of the local population, particularly through primary care services For profit, but all profits are re-invested in the purpose of the enterprise For profit, but all profits are re-invested in the purpose of the enterprise

5. How is LSE Structured Stakeholder Board 14 practices, 2 patients, 1 practice manager Patient Group Directors Four Directors drawn from practices Meets to approve direction, agree plans, authorise services, appoints directors Members drawn from practice patient groups to advise on changes in patient pathways Meet as and when – advise on strategic direction, what we do, how we do it and how its going Executive Clinical Director, Managing Director, Pharmacist, practice managers, GP clinical leads, nurses The workers, Clinical Director two sessions, Managing Director 4 days, rest project based

6. What We Set Up To Do Help local primary care services and general practice thrive Help local primary care services and general practice thrive Make Practice Based Commissioning a Success Make Practice Based Commissioning a Success Directly deliver local services Directly deliver local services

7. Services We Deliver Easy winner – joint procurement Easy winner – joint procurement Locum bank – Admin, reception, nurse, GP Locum bank – Admin, reception, nurse, GP Service provision – Resolution Health Centre Service provision – Resolution Health Centre Minor Surgery Minor Surgery Support clinical commissioning and development of Langbaurgh NHS Clinical Commissioning Group Support clinical commissioning and development of Langbaurgh NHS Clinical Commissioning Group We became self sufficient within a year Oh no we haven’t!!

8. Why Form a Social Enterprise? The environment The environment –The big things – changing face of general practice, ie PMS review, darzi, competition, big players will get bigger, takeovers lead to powerful providers, impact of the recession (more demand, less resource) –The little things - what’s happened to community services and what is happening now, increasing demands on practices, common complaints Taking control….not just be responsive or simply let things happen Taking control….not just be responsive or simply let things happen Having a single voice and resource to support all practices Having a single voice and resource to support all practices Taking advantage of the massive opportunities in working together Taking advantage of the massive opportunities in working together

9. Establishing a Separate Entity Creating a separate entity means: –Security and strength in numbers, act in unison –Empowerment for a common purpose, –Take financial risk without directly impacting on practice partnership –Hold contracts, deliver services, make profits –Partnership between practices whilst maintaining independence of individual practices –Ability to form partnerships with other bodies (All this could be achieved through a number of legal forms)

10. So Why a Social Enterprise? Its simple yet powerful concept: Its simple yet powerful concept: –Made up of its Stakeholders –For the benefit of the community –Not for Profit…….For profit but profits invested for the benefit of the community A set of rules that all 15 Practices could accept Only form that created trust between all parties Supported by Gov’t and all Political Parties Access to grants

11. Why Social Enterprise? Acceptable – patients, practices, staff, Government, all political parties, Department of Health, PCT Acceptable – patients, practices, staff, Government, all political parties, Department of Health, PCT High profile – Access national and local funding creating a foundation on which to build success High profile – Access national and local funding creating a foundation on which to build success Stay in control. Practices contribute to the extent that they wish (a for profit company is bound to expect that practices earn their share of profits) Stay in control. Practices contribute to the extent that they wish (a for profit company is bound to expect that practices earn their share of profits) Patient benefit prime purpose Patient benefit prime purpose

12. What a Social Enterprise Isn’t An easy way out of change An easy way out of change A Commissioner A Commissioner Not for profit Not for profit The Private Sector (thin edge of the wedge) The Private Sector (thin edge of the wedge) A way of avoiding tax A way of avoiding tax

13. Success in Setting Up As A Social Enterprise (1) Ensuring it is for the benefit of all, not just a few (not jobs for the boys….or girls) Ensuring it is for the benefit of all, not just a few (not jobs for the boys….or girls) Selfless leadership and face to face contact with all potential members Selfless leadership and face to face contact with all potential members Must reflect the values, beliefs and ethics of members Must reflect the values, beliefs and ethics of members Communication…communication…etc Communication…communication…etc Dedicated quality support Dedicated quality support Getting finance and legal structure right Getting finance and legal structure right

14. Success As A Social Enterprise Minimal bureaucracy Minimal bureaucracy Business - customer comes first (PCT and Patients) – understand what your customer wants Business - customer comes first (PCT and Patients) – understand what your customer wants Establish your norms and ways of working Establish your norms and ways of working Make a profit with everything you do Make a profit with everything you do Choose partnerships that complement your strength Choose partnerships that complement your strength