The Case for GP Co-operatives - An idea for GP owners

Dr Jonathan Simon, GP West Auckland

The geography of practice ownership is changing:

- Who are the new owners?

- What are the options for current practice owners?

Radius ( variable ownership stake)

East Tamaki Healthcare( 100% ownership)- group of practices that have taken over PHO function.

Peak Health (100% ownership)

Southern Cross Primary care( 20% ownership)PHO/MSOs -Midland Network, South link Health( present in Auckland), Compass

( variable)

DHBs ie West Coast ( 100%) ownership

Community trusts

Funding to practice through PHOs only, mixed ownership models Independant,Community Trusts,MSO/PHO, DHB, Corporate

- who is looking after the interests of the current practice owner?

- The PHOs ?

- What if the PHO is also buying practices? is the PHO advocate or competitor?

- Whose money are they using to buy the practices?

Four Questions:

Large practices have always been able to do much of the PHO work themselves.

Cosine PHO – Karori, is a good example

- Can you do it a lower cost?

- A good PHO has 20-25% fixed costs

Some PHOs have fixed costs of 30-40%

- What are the fixed costs of your PHO?

In a recent survey in New Zealand Doctor ( 4th June 2014)

• 83% of GPs had not seen PHO financial statements

• 68% of GP would like to have more say in how the PHO money is spent

• 88% of GPs do not know how much their PHO has in cash reserves

• 58% do not think it reasonable for PHO to use reserves to purchase practices

• 59% of GPs see a danger that practices owned by their PHO will placed in direct competition.

- How do owner-operated practices compete in a new environment that will increasingly be determined and funded based on performance?

Co-operate with a group of local practices. Co-operate when it makes sense and compete where competition is appropriate.

Work to incorporate PHO/MSO functions into your grouping

Do this yourself or use MSO services from corporate or PHO/MSO services

Aggregate a group of practices to a total population of 20-50K

Co-operate on It infrastructure, quality, performance, benchmarking,community engagement, out of hours/urgent care

Plan to include other health professionals as the concept develops

What are the elements:

1. define a common purpose: For patients and for business

2. Accept a co-operative framework

3. Critical mass ie 20-50K

4. Collective Intelligence ie DrInfo

5. Community Building is interface with community and hard to reach.

The 5 C’s (Health Foundation, London)

Build this around a project eg after hours/urgent care

Go and talk to your PHO about renegotiating an MSO contract with them and do more for yourselves and your patients

Does this occur?

Yes, and here is are some examples

East Tamaki Healthcare: in South Auckland has become a PHO and in West Auckland has 4 practices using Procare as a postbox.

NHC in West Auckland, uses Waitemata PHO as a post box for its 4 practices.

In Mid central, 4 practices have a virtual amalgamation.

Coast to coast health is a group of practices that have an MSO arrangement with Waitemata PHO

For some practices, the answer is amalgamation.

here is a publication from Comprehensive Care (MSO) behind Waitemata PHO on the North Shore

They have partners including 4 NHC practices

Coast to coast healthcare: A group of practices around Wellsford 13K patients

Coast to coast healthcare is a group of practices, GP owned with salaried practitioners who have a partnership relationship to their PHO and do some PHO functions themselves

As Coast to Coast is owned by Dr Tim Malloy who is also the Chair of the Waitemata PHO/Comprehensive Care and President of the RNZCGP

This approach seems to have significant endorsement!

Future model- PHO gone; direct relationship between groups of practices, corporates and GP MSO organisation

.IT platform manages clinical and financial risk, quality outcomes and population health; practices manage personal health.

Over time this platform may include other health professionals.