Abstract
The authors aim to contribute to the limited but growing body of cross-cultural research on the dynamic between social enterprise and systems context. They describe their experiences setting up a small social enterprise between 2004 and 2015 to deliver primary care services in England. They use a diagnostic tool to structure their discussion on the health systems context. The three domains—social impact, government systems, and health system capacity—influenced the authors' capacity and capability to realize social innovations in care to vulnerable people. This chapter will have implications for researchers, health policy makers, and social entrepreneurs with an interest in supporting the development of social enterprises, with particular reference to small social enterprises in health systems.
TopLiterature Review
This literature review starts with an overview of the health system reforms in England. These provide context for social enterprise policies and the small, but growing number of theories on system context. The next section summarises the literature on the meaning of social enterprise. The final section describes the diagnostic tool used in this research and the literature on social impact, the role of governments in health system reform and health system capacity building.
Key Terms in this Chapter
NHS: The National Health Service (NHS) provides health care for all UK citizens. In the main, it is free at the point of care and funded by UK taxpayers. It is governed by a constitution with statutory duties which are reflected in performance targets (e.g., a maximum 4 hour wait to be seen in A&E).
GMS (The General Medical Services Contract): Is the standard contract between general practice and NHS England for delivering primary care services to local communities. There are detailed rules about who can hold these contracts. The consistent feature is that one of the contract holders has to be an identifiable GP, or that a GP has to be a shareholder of a company limited by shares. These contracts are permanent.
Health System: Is the many relationships built by actors (including the general public) to lead, govern, finance, deliver services, manage resources, medicines, and technology. It may also be described by its values.
Patient List: Anyone resident within the UK has a right to be registered with a GP and to have access to the services that they provide. The total number of individuals so registered is referred to as the registered patient list. Most payments for UK general practice are paid per capita.
Hepatitis C Project: Hepatitis C is a blood born virus that is relatively common amongst South Asians born or brought up in the Punjab region. Infected individuals often do not know they have the condition until they present with late complications. WB carried out a screening project involving local Mosques and went on to treat patients who were identified as having the condition. This is normally undertaken via a hospital clinic.
CCG (Clinical Commissioning Group): Are statutory NHS bodies responsible for the planning and commissioning of health care services for their local area, for example, planned hospital care, rehabilitative care, urgent and emergency care, community health services, mental health services, and learning disability services.
APMS (Alternative Provider of Medical Services) Contract: Is one of four possible contract forms for the delivery of primary care medical services. This allows NHS England to contract with “any person” under local commissioning arrangements. It is a commercial contract and must follow a nationally proscribed format. It was first introduced in April 2004.
NHS Pension Scheme: Is a defined benefit public service pension scheme, which operates on a pay-as-you-go basis. It is only accessible to employees working within NHS organizations and a very protected wider group. Senior clinical staff in particular see access to the scheme as important.
PCTs (Primary Care Trusts): Were part of the health system from 2001 to 2013 with responsibility for commissioning primary, community and hospital care. Until 2011 they also managed community and some primary care services.
Pathfinder: The first NHS employees to receive funding and support to leave NHS management to set up independent social enterprises in 2006.