As a not-for-profit consumer owned co-operative, NHC is able to meet the needs of both the community and its GPs and help them achieve greater health outcomes . It does this through three key mechanisms, which are distinct to co-operatives and are not found in other non-profit models:
1. Member engagement: NHC evolved from a desire to meet the local community’s health needs. Member engagement has been at the heart of developing the proposition, providing patient centred care and operating NHC on a day-to-day basis. This high level of engagement also extends to GPs acknowledging the link between the service provided by GPs to their autonomy, training and working conditions.
2. Re-invest profit: NHC is owned by the community for community benefit. This means that profits are re-invested back into the co-operative to continually improve health outcomes of its members, provide GP training and development and to save for future health investments.
3. The Co-operative Principles: NHC endorses the seven co-operative principles and values accountability and transparency, innovation, justice, respect and responsiveness. These seven principles are used as a framework to guide the rights and responsibilities of patients who visit NHC centres (Patient Rights & Responsibilities Charter)17.
These mechanisms create comparative advantage over corporate medical centre operators in the ACT and nationally.
“We chose a co-op due to the financial and legal rigour. We didn’t want to be a not-for-profit; we wanted to be profitable but to re-invest that surplus into the community. We also wanted to capture in the DNA of the organisation the community concept. The co-operative had less chance of being captured by a small group, like in an association or by a single shareholder. Every member would always have the same say and all members the feeling of having a say.”
Michael Pilbrow, Co-Founder and Director
Benefits to members of the co-operative
1. Patient centred care
NHC provides the community with independence and control over the health services provided in their local community.
As a consumer owned co-operative, NHC places the utmost attention on providing patient centred care which is respectful and responsive to the needs and values of its members. The needs of its members come first. When NHC sees evidence of an emerging clinical need within the community the organisation will invest in resources to ensure an encompassing level of care – such as hiring dietitians when incidences of diabetes increase. These types of investments are made on the genuine need of patients and members, which in turn result in improved health outcomes for the members.
2. Affordable, accessible and available GPs
NHC focuses on the needs of the community by providing members with affordable, accessible and available medical and allied health services.
NHC operates as an extension of the community. The onus is on the community to support the co-operative by becoming a member, attending its centres and participating in the Annual General Meeting. Individual membership fees provide NHC with revenue to invest to provide both higher quality and a broader range of services. Non-members are charged for general practice medical services at commercial rates.
“We are the community so the benefit is having a say in whether we have doctors or not. Because the community are the owners the onus is on the members and owners to make the co-op a success. It formalises the process of support from the community.”
Adrian Watts, Managing Director
3. Investment in more and better services
NHC has developed a financially sustainable and scalable model of high quality health care to meet patients’ needs.
Since opening its doors, NHC’s policy has been to invest in the continuous improvement of health outcomes and expansion rather than saving for a rainy day. This strategy has led to the successful expansion from one centre to five full-time and three part-time centres in the ACT.
Shared value created
1. Responsive to community needs
NHC’s success today emanates from a community action for a bottom up, demand driven response to an identified community need. Maintaining a connection with the community and remembering the reason for founding the co-operative has ensured the community has remained invested in the success of NHC. Without the unwavering support of the community, NHC would not have been able to expand its operations to provide medical services across the ACT.
Re-investing profits into the co-operative has provided NHC with a significant point of difference to its competitors. For example, in the case of corporate medical centres, profits are more likely to be distributed to shareholders who are external to the business. However, NHC is able to re-invest profits to improve services as well as expand into neighbouring communities to help provide accessible and available health care.
“Our GPs aren’t told how to work or what to be billing.”
Adrian Watts, Managing Director
The NHC also uses resources to support the wider community including its provision of GPs to vulnerable and homeless people through the Uniting Care Early Morning Centre in Canberra city, engaging a specialist diabetes educator and employing bulk-billing psychologists.
2. Training and development of GPs
NHC provides a pathway for non-vocationally registered GPs to receive training and a supportive work environment and thereby attracting doctors to the local community.
The NHC operating model is optimised to support its doctors to provide high quality services. One way is to support the development of its GPs through weekly meetings. For two hours once a week, GPs meet in all of the medical centres to conduct professional development and debrief on current patient trends and needs. This represents an investment from both the NHC and GPs in enhancing patient outcomes.
NHC’s niche approach to recruiting non-vocationally registered doctors has enabled them to avoid the intense competition for registered GPs and develop their own quality GPs internally. NHC provides clinicians with opportunities to achieve specialist qualifications. In the case of those with limited or provisional registration, NHC assists them to achieve general registration on their way to completing their fellowship. Approximately 80 per cent of NHCs GPs were non-vocationally registered when they joined the co-operative.
“A lot of doctors come into the country but they aren’t able to get the training and oversight and meet the high accreditation standards. The co-op takes the opposite approach [to corporates] because we want more GPs in the community, so we are happy to train and supervise these doctors. This niche is what makes us really successful.”
Dr Joe Oguns, Medical Director
3. Better health outcomes
While NHC monitors and evaluates member health outcomes on a patient-by-patient basis, they are yet to measure the social and economic improvements to the community as a whole. However, research on health outcomes indicates that:
“…patient-centred care improves patient care experience and creates public value for services. When healthcare administrators, providers, patients and families work in partnership, the quality and safety of health care rise, costs decrease, provider satisfaction increases, and patient care experience improves. Patient-centred care can also positively affect business metrics such as finances, quality, safety, satisfaction and market share20.”
Patient centred care and integrated health services has been shown to result in fewer hospital admissions and re-admissions, better medical outcomes and improved quality of life23.