The £6m per year contract was out for tender because the current service provider, York Hospitals NHS Foundation Trust, gave notice on the contract.
So we set out to get the best for Whitby. We spent much time developing a joint view with patients and the public and the local health staff about what we wanted and we warmed up the market, encouraging providers both local and national to participate.
We chose competitive dialogue because although we knew it would be a resource intensive thing to do, it would give us the best chance to find the right provider for the job. What is competitive dialogue?
We used competitive dialogue to decide the winner
Well, rather than the process being mainly paper-driven (providers simply supplying written answers to questions) and then holding a single interview, competitive dialogue is a series of detailed (four-hour) face-to-face conversations with each of the potential providers, developing within them the details of our joint ambitions for the services.
By the time we arrived at the decision-making phase we had talked to each of the final two providers for 34 hours! We also assessed them through written submissions which included each provider answering a long series of questions marked by pairs of subject matter experts (37 in total), including a patient and public panel.
We visited places where the organisations already provided services to talk to staff, patients and commissioners of those services. The visiting team included CCG staff, both managerial and clinical, members of staff from the Whitby services, a member of the public and a local councillor.
Those visits gave us the chance to triangulate information we had received in both written and verbal interactions with the providers. We allocated 70% of the marks to the assessment of quality of care including patient experience, with the remaining 30% covering financial capability.
Dealing with conflicts of interest
How did we deal with conflicts of interest? We were told that our local GP federation had developed links with one of our potential providers and therefore the GPs working for the CCG who are all members of a single federation were 'conflicted' and could not be part of the process.
We created separate senior management teams to cover the Whitby work which excluded them, and we brought in clinical advice from other CCGs where no conflict existed to support decision making.
Although I have been a GP in this area for 26 years I no longer work in primary care so I was able to lead without issue.
In the end, the process led us clearly and simply to the answer. One provider could offer us the best service for Whitby. They are ambitious. They have a track record which is strong for engaging and involving patients in everything they do and for empowering and developing staff to improve the quality of local services.
Virgin Care had a strong track record
Are there challenges? Of course. When you do a job like mine you know what you are taking on. I am a public servant. I follow the rules laid down for my organisation by parliament. I am also an individual with my own private views and opinions. I vote. As I do my job I am bound to reflect privately on issues that chime with or challenge my personal views.
I learned a great deal through this process and yes, it challenged some of my personal views. Whilst we were visiting the Virgin Care site in Surrey, a nurse who I asked what it was like to work for the company told me that one of her most challenging encounters had been with a GP. She pointed out that she thought that was a bit much considering that GPs are themselves private providers!
This made me think. I see myself as NHS through and through, and yet as a GP partner in a practice for my entire career I have been a profit-making partner in a small private business, as all GP partners are and have been since the birth of the NHS.
We made decisions week by week which affected how much of our money we invested in staff and services and how much we took home as pay. It is profit/loss at the sharp end.
In conversations with Whitby staff, someone said they were sad that an NHS organisation was not able to offer something as credible and ambitious as a private organisation.
Confident we made the right decision
It made me look back over our process and consider if we had done everything in our gift to stimulate and develop the market both private and NHS, and I am confident we did: we held several open events, made many conversations both formal and informal.
What about the staff? Our NHS staff in Whitby will transfer to the new provider with their terms and conditions of employment intact and will be able to stay in the NHS pension scheme. More importantly, as they develop and progress, and their roles and pay change, and as new staff come in, they will also be able to choose between NHS terms conditions and pensions and those of Virgin Care.
Staff at the site we visited talked enthusiastically about great opportunities to develop and progress they had been offered since Virgin took over for all staff groups. A nurse told us that she had been dragged 'kicking and screaming' to work for Virgin but she had to eat her words because they were a good employer who cared about staff and patients.
Why do NHS providers occupy the ethical high ground?
It is easy to somehow think that NHS providers occupy an ethical high ground. But do they? In conversations since the announcement people have quoted to me programmes and articles about the shortcomings of private providers.
However, they are not alone. How many are there about NHS providers if you look for them? The system we work in is not perfect. Sadly there is poor performance in all sectors. We must and do strive to improve the quality of the services we offer our patients and we are committed to continuing to do that.
Will the political landscape and thus our framework change? Possibly. The private sector involvement in the NHS has been sanctioned by both major political parties when in government. Will it change? Possibly, but if it does we will manage that. That is our job.
Real improvements for patient services
We are confident the robust and clear process we have been through will lead to real improvements in services for patients in Whitby. We will to continue to work closely with the patients, public and staff as commissioners of the service to shape and develop services over the next seven years.
So when people ask me whether I am privatising the NHS, my answer is a simple one. As a public servant my job is to improve the quality of our services and I use the framework given to me by parliament to do that. I do not make policy. I am not a politician. So no, I am not privatising the NHS. I am doing my job.
- Dr Pleydell is GP and healthcare commissioning lead for Hambleton, Richmondshire and Whitby CCG
