Whether it is physiotherapy, osteopathy, sports therapy or chiropractic – small, local private MSK clinics have much to offer their communities.  They provide a personal experience where the practitioner knows their patient and their past medical history. The clinician can draw on previous experience to determine what treatments are effective for that patient. These small to medium sized enterprises (SME’s) are often owned and managed by a founding principal who accepts that he/she is only as good as their last treatment. The principal ensures that associates are extensions of his/herself and they carry with them the responsibility of maintaining a good reputation for the clinic

Despite the free market that has been created by the AQP process, I believe their future is under threat.

Their first problem is a logistical one. If there are 100 small (e.g. 1-5 employees/ associates) private clinics in a Clinical Commissioning Group’s catchment area how will it be possible for the commissioner to listen to all of them and make judgements on each. Given the time frames and path of least resistance it is so much easier to recognise large providers that can offer the scalability of providing services across the CCG region.

Secondly, what will happen to these small providers if NHS MSK services along with the large providers such as Virgin Care and Care UK rise to the challenge of providing better, more accessible and cost effective services. Loyalties to established relationships between existing patients and their local, private provider will be tested. Why pay for private treatment when you can get it for free in the new and improved health market? It is hard to see how loyalty can be sustained in the mid to long term.

There are other barriers that will need to be confronted by the SME’s. For example there is a necessity to implement the ‘Choose and Book’ NHS system. This means an investment in time, energy and finances…, it will require the introduction to the N3 telecoms infrastructure and all the IT governance and costs associated with it.

So what does the future hold for SME’s?

I believe that the most likely outcome in the short term will be that small clinics will rely on subcontracted business from a large prime provider. It will mean adhering to conditions set by another organisation. This ultimately impacts on the clinic’s autonomy.

In the mid to long term I think small clinics will discover the benefits of forming official consortiums. They will need to be set up as legal entities to qualify for AQP recognition and would most likely have representation on their board from the members of the network. They will need to establish standard terms and conditions and meet all the requirements of AQP. They will then be able to engage commissioners with a unified voice and enjoy greater control of their destiny.

To all small, local providers the message is clear… start engaging with neighbouring clinics now !

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