Interview: Lessons from the private sector

GP Dr Neil Goulbourne, Virgin Care's head of innovation, tells Marina Soteriou what practices can learn from the private sector.

Virgin Care’s Dr Neil Goulbourne: ‘We live or die on the basis of our record and quite rightly so’
Virgin Care’s Dr Neil Goulbourne: ‘We live or die on the basis of our record and quite rightly so’

The debate over private sector involvement in the NHS is old, says Virgin Care's head of innovation, GP Dr Neil Goulbourne.

'Companies like us have proven that the private sector can bring something that the NHS values,' says the practising GP who until last month was the company's head of primary care.

Virgin Care took on its first GP practice in April 2009. Now it has 18 practices, another eight with walk-in centres attached and nine walk-in only centres, including urgent care centres.

It beat off 17 other bids for its latest acquisition in February, a Dorset APMS practice.

Speaking from its glass-fronted eighth-floor offices, overlooking BMA House in central London on one side and the City on the other, Dr Goulbourne explains Virgin's approach to taking over GP practices. 'We are not there to just paint everything red,' he says, referring to the company's famous branding.

The company does want to 'challenge the status quo but in doing so we don't just pluck ideas out of the air', says Dr Goulbourne.

Working with staff

Its 'innovative' approach is based on looking at practice data and working with staff and patients, he says.

No solution is a 'silver bullet' according to Dr Goulbourne, but he says it is important for practices to realise that they can make 'substantial changes' through a wide range of smaller changes.

So in one practice they use a nurse practitioner for all on-the-day appointments, leaving the GPs free to deal with chronic disease management.

In another, GPs have up to half an hour per consultation because all patients see the nurse practitioner first. Only if they are referred by the nurse do they see a GP.

The company does not have a practice manager in every practice but instead, shares them across one locality with an 'administrative lead' on each site.

So how can primary care learn from the Virgin Care approach? Smaller practices could work with others to share back office functions as well as clinical services, such as on-the-day appointments, home visits or the care of a nursing home, suggests Dr Goulbourne.

'There are plenty of opportunities there for GP practices as providers outside of the context of a CCG to collaborate and improve what they are doing and perhaps reduce their cost base,' he says.

Cheaper services?

Are commissioners choosing Virgin Care over other primary care providers because it can offer a cheaper service?

'The important question is the quality of care and the price at which it comes to the NHS,' says Dr Goulbourne. 'Commissioners are choosing on the basis of those things.'

Dr Goulbourne admits the company's size places it in a favourable position with commissioners. But he insists that it is only because it has a good track record which it is able to include in its bids.

'We live or die on the basis of our record and quite rightly so,' he says. Even though as a private company, Virgin Care does not have to comply with Freedom of Information Act requests, Dr Goulbourne says it has a 'real culture of openness'.

The company has never been sent an FOI request directly but it does have to supply commissioners with information if they are sent one about services it provides.

Virgin Care
First GP practice opens in April 2009.
Now has 18 practices, another eight with walk-in centres attached and nine walk-in only centres, including urgent care centres.

 

Dr Goulbourne adds its primary care contracts contain a large number of key performance indicators which it has to report on to commissioners, on a monthly basis.

As for the patients, Dr Goulbourne says their feedback is just as important. The company has rolled out its version of the friends and family test, asking patients if they would recommend the practice to a relative or friend. Practices also have to display a poster explaining to patients what actions they have taken to address any issues raised.

'We get a response rate of 50 or 60% which is an awful lot higher than the rest of the NHS,' says Dr Goulbourne.

The role of private providers in the NHS looks likely to grow, so practices may be able to learn the lessons from organisations like Virgin Care, which has the capacity to experiment with new solutions.

marina.soteriou@haymarket.com

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