Our Governance Framework
The Central London Healthcare Governance Framework is designed to assure adequate accountability to our Members, commissioners and stakeholders, and to encourage performance improvement while meeting our obligations and legislative requirements. It defines relationships and the distribution of rights and responsibilities among those who work with and in the organisation, determines the rules and procedures through which the organisation’s objectives are set, and provides the means of attaining those objectives, monitoring performance and managing risks.
CLH is owned and operated by the Council of Members. Members are made up of GP member partners from Central London Practices who have mandated an elected Board to develop Primary Care strategy and lead CLH.
10% of the UK population now have 4 or more Long Term Conditions and this is expected to double over the next 20 years. Two thirds of these people also suffer from cognitive impairment, dementia or depression (BMJ, 2018).
Delivery of healthcare must in future reflect the need for highly skilled generalists working with the support of a larger scale organisation.
Cost effectiveness of scale and consistency of offer: avoiding diseconomies of scale and unwarranted variation in delivery
The role of CLH is twofold:
- To work with Members and commissioners to develop and deliver services on behalf of Member Practices
- To develop a strategy on behalf of members, and deliver this agreed strategy through representation and action
CLH operates as a Community Interest Company (CIC) in order to be recognised as a leading GP provider network, run by clinicians for the benefit of our local population. We will achieve this by working with patients and partners to ensure that general practice remains sustainable and independent.
CLH is a Large Scale GP Organisation (LSGPO) that has operated successfully in Westminster for over 10 years. The practices are arranged into four geographically aligned Primary Care Networks each serving populations of between forty five and sixty five thousands.
The four Central London Primary Care Networks (PCNs) and their member general practices will be the delivery vehicles for a new Integrated Primary Care offer within Central London CCG. The PCNs will offer primary care services integrated around the needs of an individual service user whilst serving a whole geographic population. Delivery of care will consistent across the patch; the service offer will be agreed, made explicit to and understood by all participants; service users and carers, as well as the commissioners and providers of services.
As a Community Interest Company (CIC) Central London Healthcare embraces the commercial discipline required to generate profit from the work we do whilst ensuring those profits are reinvested in development of new services for NHS patients.
CLH CIC recognises the risks and opportunity cost to commissioners and taxpayers associated with investing in our business and strive to ensure a fair return on any such investment.
The PCN workforce includes pharmacists and mental health and social care navigators who are employed by CLH reflecting its vision for a Primary Care Network as a ‘multidisciplinary team with generalist values’. This team will expand within the DES contract.
CLH is run by a Board with elected representatives from all four PCNs advised by a small executive team of managers and clinicians. The Board can direct financial, managerial and clinical resource to activities which board members believe will generate the best returns for the health and social care economy within which it operates. As a small and nimble organisation, CLH can explore opportunities at speed.
The performance of individual member practices and the PCN as a whole is interpreted and fed back to the PCN clinical and managerial leads by the CLH executive team.
All member practices send representatives to monthly Primary Care Network meetings. The inherent competitiveness between the member practices drives up performance as details of the practices activity is shared amongst all at Primary Care Network meetings. Individual practices may also be offered support by managerial and clinical executive team members under the direction of the CLH Board
CLH CIC thus combines the delivery of care with strategic planning and budget responsibility for a whole population.
CLH's aims include to:
- Improve the health of our population
- Improve individual experience of care
- Improve the experience for the workforce providing care
- Reduce the per capital cost of care
Operationally this means that CLH will:
- Develop the general practice team
- Combine physical and mental health service delivery
- Expand access for patient to the whole general practice team including virtual consultations
- Improve the management of long term conditions
- Reduce unwarranted variability between general practices in the quality of service they offer
- Reduce unplanned hospital admissions
- Support self-care for patients
- Enable further scaling up general practice: sharing back office functions: developing digital solutions
- Develop CLH's existing referral management function to include referrals between general practices as well as from general practice to other Community and secondary care services
- Develop alternative ways in which CLH patients can access consultations - online and provided by CLH on behalf of its member practices
- Develop further the Care Navigation role, social prescribing, DES workforce funded roles and the Integrated Care Team (ICT)
- Develop fully integrated partnership working between CLH as a Large Scale GP Organisation and other providers of health and social care.
In a recent report to the Parliamentary Health Committee Simon Stevens identified the following characteristics of organizations which had improved care despite funding challenges.
- Strong leadership
- Culture which empowers staff
- Shared vision
- Engaged staff
- Outward looking approach.
CLH can demonstrate its achievements and our commitment to future development in all of these areas. CLH's newly acquired role as a Training Hub for Health Education England will assist in facilitating this.