Social enterprises: doing NHS business without the bureaucracy
Nisha Desai, head of medicines management at social enterprise company Provide, speaks to pharmaphorum about how such organisations are benefitting the NHS, prior to her appearance at a major London conference.
Provide is quite an unusual supplier of services to the NHS because it is a social enterprise – could you describe what its aims are, why social enterprise status makes it different, and how that helps patients?
Yes, Provide is a Community Interest Company – a social enterprise. This means it is a business with primarily social objectives and, in addition, ours is owned by its members.
It means that any profits we make are reinvested into the local community or back into the business, and do not go to shareholders and owners. Other well-known social enterprises in the UK include The Big Issue and The Eden Project, for example.
Our vision is to be a leading provider of integrated health and social care, delivering quality services that are effective and safe whilst providing a good patient experience and value for money.
We are nationally recognised, having won the Social Enterprise of the Year award 2013, National Business Awards 2013 and the Employee Ownership Association’s Public Mutual of the Year 2013.
We deliver a broad range of health and social care services in the community, and are committed to making sure that they are safe, responsive and of high quality.
We work from a variety of community settings, including three community hospitals, community clinics, schools, nursing homes and primary care settings, as well as in people’s homes to provide over 50 services to children, families and adults.
We provide services across Essex, in Peterborough and Cambridgeshire, as well as in the two London boroughs of Waltham Forest and Redbridge. We have an income of approximately £54 million, employ over 1,100 people and serve communities with a total population of more than 1.9 million people.
Surpluses are invested back into the development of our staff and services; to charities and community organisations to support health and wellbeing. For example, in Essex we have donated sums to Age UK, Support for Sight, Autism Anglia, Home Start and Parkinson’s UK. We have set up foundations with the two universities in Essex to enable bursaries to be provided for local people wanting to study or train in healthcare.
We have an NHS ethos but not the bureaucracy; being a social enterprise has meant staff are free to innovate and supported to try new ways of doing things to improve services for patients. For example, a speech and language therapist was supported to trial the use of FaceTime on iPads as a way to deliver clinical sessions remotely. This involved the patient at home with one iPad and the clinician in the hospital with another. This has proved clinically effective, saving the clinician time and saving the patients from having to travel to hospital for appointments.
What is your role as Head of Medicines Management? What are your key priorities?
My role is primarily to ensure we comply with medicines legislation and keep abreast of quality and safety in relation to medicines. I also support our services to procure appropriate medicines for their clinics.
In addition, I am involved in training our staff on medicines management processes and supporting CPD [continuing professional development] for our non-medical prescribers. I am accountable for all medicines-related processes within the organisation and keep abreast of legislation and key updates to support all of our services.
Key priorities are:
• Translating medicines legislation into policy and procedure to support service delivery
• Meet the requirements of our regulator, the Care Quality Commission (CQC), by meeting the outcomes related to medicines management, which include robust governance procedures and medicines security and safety
• Meet the commissioning standards as outlined by our commissioners for service provision, some of which may have fines associated with them if we do not comply
• Build a good network of internal and external stakeholders to ensure we are kept up-to-date and informed on regional initiatives and projects
• Manage and deliver medicines management training for the organisation and support the delivery of training associated with medicines resulting from MHRA [Medicines and Healthcare products Regulatory Authority]/NHS England safety alerts
• Manage and deliver the medicines management business plan and support the delivery of the organisational clinical strategy
• Oversee and manage the reporting of medicines incidents and investigate where appropriate
• Collaborate with NHS East of England and Midlands and other national and regional teams to support delivery of medicines management within Provide e.g. attendance at Chief Pharmacist meetings and meeting with other community service providers to make informed decisions on priorities and relate these to our business
• Oversee the procurement of medicines for all services requiring these and manage these contracts from a medicines management perspective.
I understand you have also worked in the pharmaceutical industry. Can you describe what you have learned from working on both sides of the fence that others (who haven’t) don’t understand?
The pharma industry, in my opinion, has a lot to offer the NHS in terms of knowledge, resources and support. Having worked with industry colleagues, I find them professional and extremely knowledgeable and resourceful; the challenge is getting this across to the NHS without the sales pitch.
Pharma companies can support the delivery and development of care pathways as they have more knowledge about particular diseases and their treatments than we do.
The key is in putting this in such a way that it does not come across as a sales pitch. Many pharma companies have non-promotional roles and I have used this knowledge on many occasions to work with pharma to support me in delivering good training sessions for our staff. For example, diabetes training to comply with the patient safety alert on insulin.
The NHS is a complex arena and it is important to understand your customers’ business; I talk to many pharma reps who actually do not understand social enterprise organisations and what they do.
“It’s also really important, in my mind, to ensure information is tailored to the recipient”
It’s also really important, in my mind, to ensure information is tailored to the recipient. I would not be interested in hearing how pharma can help GPs in meeting their Quality and Outcomes Framework requirements, for example, but I would be interested in how pharma can help me in meeting my organisational training requirements for medicines management and how it can help me support our healthcare professionals with their CPD.
Another key area for me is audit and how pharma could help to support this in practice. For example, I recently worked in collaboration with a medical nutrition company to develop, audit and deliver key findings on nutrition and oral nutritional supplements, in line with NICE guidance, within our community hospitals. This has resulted in further work around training, report writing and we are also preparing a poster to go to the Pharmacy Management National Forum in November.
Medicines management is often seen as cost containment by the pharmaceutical industry. Is that an unfair reflection of what happens across the NHS, generally speaking?
Unfortunately, this stigma, which is still very much embedded in medicines management, is a result of the days when this was definitely at the top of the agenda. Now, medicines management is more about improving quality via medicines optimisation and ensuring safety.
So, yes, it is an unfair reflection but I would encourage pharma to see past this and look at opportunities to work with the NHS to improve patient outcomes and experience.
What would your advice be to the pharmaceutical industry in terms of how best to engage with medicines management leaders and other decision makers?
The best advice I can give is to make sure you do your homework and know who you are talking to; have an understanding of what kind of services they provide and what their key challenges are.
Think about how you can help them deliver better services for their patients within current limited budgets. This will help improve the quality of the service being provided for less outlay and ensure we achieve the outcomes we desire, such as training, audit development and pathway re-design.
Also, consider your value proposition and how you think this would fit with current local challenges, as well as considering national priorities.
About the interviewee:
Nisha Desai is head of medicines management at Provide. She will be speaking about using collaboration to accelerate growth opportunities at CreateHealth London on 24 October.
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