Allied Health Professionals Suffolk (AHPS) is a small social enterprise in Suffolk, offering musculoskeletal physiotherapy and back and neck services to around 2,000 new patients each month across 13 NHS clinic bases. Jo Douglas, chief executive, took the time out of her busy schedule to talk to us about their journey to becoming a social enterprise.
What was your motivation for applying to become a social enterprise?
As a team of physiotherapists, we wanted to be in control of our own destinies. To have the freedom and flexibility to act in a way that we felt was best for our patients and staff.
It was not an easy decision, particularly given staff’s understandable concerns around maintaining their terms and conditions. But, under the Government’s Transforming Community Services programme, our service was going out to tender and there was a great deal of uncertainty about the future. If we had moved to an acute setting or a private provider, we would not have been able to have as much control and influence over the development of the service.
How did you find the application process and what were the biggest challenges?
A very challenging one, but chances like this don’t come along in life very often, I couldn’t walk away from it!
For nine months, I had to juggle my role as head of service for nine practice areas within Suffolk provider services, which was demanding in itself whilst also developing our social enterprise application. From the outset, you must be incredibly committed and have the genuine belief that it is the right thing to do.
As you progress through the process, you constantly have to demonstrate that you are a viable and sustainable organisation, so it was a very quick and steep learning curve. We had to develop our business acumen, submit an expression of interest and an outline business plan, and engage our staff in our plans, all whilst continuing to manage nine service areas within the PCT.
Having started the application process in March 2010, it then took twelve months to be appointed in shadow form and we went live on 1 July this year.
The assurance process is very thorough, as you need to provide evidence to your primary care trust and strategic health authority, that your planned organisation will be viable and sustainable. We wanted to feel assured that we were providing a safe and secure service. As we are outside of the CQC registration criteria, we decided to build in the Health Professions Council and Chartered Society of Physiotherapy standards into the assurance framework, so that we could demonstrate we had strong clinical governance practices.
We also made sure that we had all covered all of the requirements within the SHA assurance framework. So once we were ready to go through the final assurance process it was quite a quick and easy process, as we had thoroughly prepared and put in a lot of background work. It took less than a week to become registered with the Community Interest Company regulator.
The majority of social enterprises are large organisations, so finding a mentor organisation was quite challenging. It would have been so useful, to share experiences and learn from each other from the very beginning. That’s why I am also so passionate about sharing our experiences with others, if I can help them on the journey.
Did you receive any additional funding?
We successfully applied to the Department of Health’s Social Enterprise Investment Fund for additional monies. We used this to seek legal and financial advice from the local business community, which was incredibly helpful in developing a strong and useful business framework.
Some of the money was also used to backfill my post at NHS Suffolk which meant I could work full time on the project for the final three months before go live which was fantastic. We managed to achieve so much in such a short space of time.
How did you approach staff engagement?
You have to put a lot of time in to talk to your staff, so they understand what’s happening, why and their role in making successful change happen.
We talked to our staff as much as possible throughout the whole application process. From getting them to buy into the vision of the new service from the very beginning to go live 18 months later. We had whole team meetings which included a union officer, two 1:1 slots, open door surgeries at each site, newsletter and FAQs. We wanted to ensure staff felt encouraged and able to ask as many questions as they needed.
Their biggest concerns were around protecting their NHS pension and terms and conditions. Particularly given some staff had worked in the NHS for 20 or more years. We knew that getting direction body status from the NHS Pensions Agency so that staff who transferred across could remain members of the NHS pension scheme was critical. This was granted two days before our go live date. New AHPS staff are offered an alternative scheme.
What are the benefits to becoming a social enterprise? Have you been able to develop any services as a direct result of spinning out of the NHS?
As our team have started to understand more and more about what it means to be a social enterprise, they have become more and more enthused. The whole team can be proactive in how we develop the business and the energy that is creating is fantastic. Previously our staff worked in the NHS, now they are much more active participants.
My team has always been busy and worked hard, but now as part of AHP Suffolk, they have a really positive mindset and now deliver great patient care with just more impetus. Waiting lists are significantly down on previous levels, and patient numbers are growing rather than dropping.
Working as a social enterprise means we can quickly mobilise and initiate changes to the way we work, as we are free of bureaucracy and red tape. We can also recruit new staff very quickly when needed. We are also able to go out and look for new opportunities, propose flexible services and we are able to act much more swiftly. It is much easier to see the big picture, keep control of the core whilst still having flexibility around the edge to innovate and try new approaches. One example of this is we have established a new pathway for people with osteoarthritis of the hip, helping people to improve their general health and possibly avoid surgery, At the very least, if patients do still need surgery they will be in a much better physical condition.
We are also just starting to deliver a new re-enablement service; supporting employees to remain in work. We are starting small, with just one patient but we hope that the work will grow. This kind of work is also a fundamental part of our company values, supporting the local community.
Are you worried about the sustainability of the organisation? What are your ambitions for the future?
Our ambition is to extend our offering to include other allied health services, not just musculoskeletal; through the traditional tendering route, as well as looking at developing partnerships with other organisations or creating totally new services and widely marketing them.
We are already having informal discussions with partnership organisations, about new services we could offer.
How have patients reacted?
Their feedback, which has been gathered through a satisfaction survey and an expert patient panel, shows that they are really happy with the service and the new way of working:
‘I am really impressed with the service. I was emailed exercises to do and only had to wait a couple of weeks to be seen. I am now having an appointment once a fortnight and it’s really helping’.
‘Very sceptical at first but turned out to be a first rate service’.
What words of advice would you give to other AHPs who may be thinking about becoming a social enterprise?
Before you start on the journey, think really hard about why you want to become a social enterprise. If you think a social enterprise model could develop and change your service for the benefit of staff and patients, then you should definitely apply.
But don’t underestimate the time it’s going to take and the commitment you need to have. It is a big thing to undertake but don’t be daunted by it as there are some great rewards at the end of it; being the master of your own destiny, knowing you can make a difference, working with a highly motivated and enthusiastic team who have so many great ideas. It feels like a brave new world and it’s exciting to be a part of it.