Clinical commisioning groups could use the services of friendly societies as prime contractors – and keep the NHS free at the point of use. Adam Wildman and David Fagleman make their case

It is now generally accepted by commentators and clinicians that the NHS is on financially unsustainable footing.

Current projections – irrespective of any funding required for emergency care – for long term conditions will alone bankrupt the health system within a decade.

Along with an ageing population and the steady increase in the cost of drugs and surgery, the rise in those suffering long teerm conditions means the NHS is barely able to meet present demands, let alone future burdens.

Essential integration

It is widely agreed that the future of healthcare delivery lies in better service integration and moving care to a more appropriate and cost effective setting.

In this way the ongoing care needed to treat complex and chronic conditions can be delivered and money can be saved.

In its current form the system provides fractured care which atomises the needs of patients. The better care fund, beign reviewed this week by the Cabinet Office, was deemed to be a continuation of this soiled care.

‘Mutuals are democratic and benevolent organisations and perfectly placed to inclusively integrate patients’ needs with the capabilities of clinicians’

In ResPublica’s latest report, Power to the People: The Mutual Future of our National Health Service, we argue that by embracing mutualism the NHS can deliver the integrated care needed that is so often absent.

Mutuals are by their very nature democratic and benevolent organisations and are perfectly placed to inclusively integrate patients’ needs with the capabilities of clinicians.

Existing in a competitive environment they would also improve levels of competition for NHS services in the same way as the private sector, yet would do so without excluding those patients that cannot access private medical insurance.

Mull over mutualism

This move to mutualism is not an outlandish suggestion.

Mutuals already have a firm foothold in the NHS in the form of quasi-mutual foundation trusts and NHS spin-outs.

But a mutual model that can perform the integrating role required to deliver whole person care has yet to be developed.

One type of mutual organisation that has often been ignored, but could perhaps perform such a vital role, is friendly societies - mutual associations that traditionally provide sickness benefits and life insurance.

In the report, launched in Parliament today, we propose a healthcare commissioning model that promotes enhanced service integration.

This is now possible in the NHS through the introduction of the prime contracting model in the new NHS contract. This model enables commissioners to access the expertise of a consortium of partners, each with a specific specialism, while only contracting out with a “prime” contractor for the organisation of the whole care pathway.

‘Prime contracting represents an invaluable opportunity for friendly societies’

Prime contracting represents an invaluable opportunity for friendly societies.

Many operating in healthcare already utilise a similar commissioning model and provide support to their members through a discretionary mutual fund, collaborating with private and charitable organisations to provide healthcare for their members.

The services they provide are intended to compliment, rather than replace, those provided by the NHS. Because of this they are primed to act as the integrator organisations needed for joined up NHS commissioning.

However, in the current fiscal environment such a system must perform this integrating function without any additional financial burdens on already pressured NHS budgets. That is why under our model we propose this fund be paid for out of current efficiency commitments established under the quality, innovation, productivity, prevention programme.

Clinical commissioning groups would utilise the services of friendly societies as prime contractors for all those with long term conditions in their area.

Big benefits

The benefits of this model could potentially be vast.

At their GP’s discretion, instead of a patient accessing a fractured system of care, NHS patients would access a friendly society’s services and their partners in an integrated care pathway.

This would reduce the strain that long term conditions place on the NHS and provide the patient with an efficient and simple pathway of care, undoubtedly provided in a more appropriate setting.

‘Better integration can produce a raft of savings’

Indeed, better integration can produce a raft of savings. As discussed in a recent Monitor report, moving care to the most appropriate setting could save approximately £4.5bn.

This model – in contrast to usual health insurance options – sees the re-calibration of tax-funded care rather than its replacement.

It would avoid administrative and actuarial costs associated with insurance schemes, and by utilising the prime contractor model ensure no new structural or administrative layers be added to the NHS.

Where a rise in taxes or the introduction of a new change for services may provide much needed funds, they fail to produce savings and are deeply unpopular.

Our model delivers integrated care and cost savings without the need for additional taxation or funds derived from charging. If you want to keep the NHS free at the point of use, it must be mutual.

Adam Wildman is research manager and David Fagleman is a researcher at ResPublica