Partnership of East London Cooperatives governance review

How GGI’s input helped the leadership of a London primary healthcare community benefit society steer themselves away from an existential threat to becoming one of health secretary Wes Streeting’s exemplars

Partnership of East London Cooperatives (PELC) is a provider of urgent and out-of-hours primary care services across the London Boroughs of Barking & Dagenham, Havering and Redbridge.

PELC is set up as a community benefit society, designed to serve the interests of the community and operate on a not-for-profit basis. It is governed by a council elected from the local primary care community and members of PELC staff.

The case for change

Following a CQC inspection in 2023, PELC found itself needing to make swift changes to the way it worked to continue delivering services. Its situation was described by the senior leadership as an existential threat.

With the support of the local integrated care board (ICB), GGI was engaged to carry out a governance review with the aim of ensuring that PELC had the governance arrangements in place to deliver sustainably high-quality, safe services, with a focus on how the council and its subcommittees were functioning.

GGI’s approach

There were several elements to our initial work with PELC including interviews with board members, review of key governance documents and meeting observations.

After commencing the work, including a rapid diagnostic review, we quickly identified foundational gaps in PELC’s governance that were creating barriers to carrying out the review as initially commissioned.

We proposed pivoting our focus to help implement basic governance fundamentals that would help PELC operate more effectively and efficiently. With the support of the chair, chief executive and the ICB, we did this by providing one-to-one and small group coaching support for board and committee chairs and executive leads, and supporting the development of the following essential governance documents:

• terms of reference for the board and its committees—using modern plain language formats and making explicit the purpose and duties of each committee, ensuring that each adds value and avoids duplication
• business cycles for each committee, providing a forward plan, and making explicit the purpose of meetings and papers (e.g. for decision, information, or assurance) and the data required to support them
• templates for agendas, minutes and meeting papers that explicitly state the purpose and communicate the right information in the right way.

Following this work, we carried out a review of how the council and committees were functioning, supported by induction and development sessions for the newly reformed council, which included these key areas:

• the role of the board and its committees
• risks and assurance
• fundamentals of working as a community benefit society.

Recommendations and results

Our initial recommendations included rapid implementation of the tools developed, continuous reviews of governance and skills development for the council.

After implementation, PELC quickly noticed that the way the council worked together and members’ understanding of their roles improved significantly. This renewed focus on assurance and strategic direction supported PELC in its commitment to improve services and address the deficiencies reported by CQC.

PELC has continued its trajectory of improvement and is now seen as an exemplar in providing GP-led urgent and out-of-hours care, establishing connections with similar organisations across the region.

PELC runs two urgent treatment centres within the A&E departments at Barking, Havering and Redbridge University Hospitals NHS Trust, whose overall A&E performance has gone from one of the worst in the country to one of the top 20 nationally and second best in London over the past year.

The improvements to the urgent treatment service at King George Hospital caught the eye of health secretary Wes Streeting, who described it as a model he would ‘like to replicate across the country’.

Reflecting on the changes

The council and senior leadership acknowledge that this shift would not have been possible without addressing their governance.

PELC chief executive Steve Rubery says: “When GGI came in, we needed to sort out some things urgently, including big deficiencies in governance. There was real value in being able to shift focus to how the council and committees should function. Reworking the terms of reference provided greater ownership and understanding and a foundation to manage some of the ineffective behaviours that we were seeing.

“Thanks to GGI’s support, we now have a revised council that is functioning as it should: focused on strategy and assurance rather than getting into the weeds of operational concerns. Members understand their roles and meetings run more smoothly, and this has been further embedded with the development sessions that GGI facilitated. We are more able to think about our wider goals and objectives for the future.”