Doctors’ Cooperatives as Social Enterprise: A Transferable Model?

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September 20, 2013; The Guardian


A few weeks ago, NPQ covered an editorial in the Guardian that pointed out some of the differences in the way “social enterprise” is being explored in different countries. The author pointed out that in the U.K., the term is more often used to designate organizations with a cooperative intent, rather than the single-star entrepreneur model we so often see here in the U.S. This story exhibits that those differences are rooted in history and contain some models we should be considering.

At their height, there were 300 General Practitioner cooperatives in the U.K., representing 30,000 doctors. These cooperatives allowed doctors to share responsibility for “after hours” service requirements, but after the requirement was relinquished in 2004, many of the co-ops disbanded.

Now, these cooperatives appear to be coming back, but in slightly different form, as providers of only after-hours service. “GP co-operatives is an old fashioned term now; it practically doesn’t exist,” says John Horrocks, chief executive of Urgent Health U.K. On the other hand, social enterprises now account for around 42% of the out-of-hours market. “It’s not the same as it used to be, where everyone took their turn in a co-operative,” says Horrocks. “It’s more of a lifestyle choice. Now, you often find GPs who specialize in out-of-hours … typically, a shift rota is available on the Internet and the GP is able to sign up to whatever shifts they want to work.” But the social enterprises do retain the cooperative ethos.

Chris Wright, chief executive of Devon Doctors, says, “the knowledge that no player in the company—be they director, employee or member—can benefit financially beyond a reasonable wage is vital in keeping the values of the company focused on sustainable quality care…There is no profit to be made in out-of-hours care, the resource is very limited, so ‘for patients not profit’ is the best ethos.”

“The (contract) win rate for social enterprise is very good. As long as we can manage to persuade commissioners that what they want is a good quality, value-for-money service, rather than what the commercial sector tends to provide, which is a lower cost service but we would say dodgier quality…very often the commissioners are persuaded to go for social enterprise these days.”

In fact, Devon Doctors is planning to bid for other primary care contracts, particularly services like nursing and walk-in centers released under the Transforming Community Services initiative. Wright comments, “We believe that our social enterprise model would ensure that contracts are focused on quality care for patients rather than extracting a profit.”—Ruth McCambridge