Why and how to replicate public service mutual models at scale within health and social care

In our report for DCMS, we examine how widespread adoption of mutuals can be achieved within the health and social care sector.



  1. Executive Summary and Key Recommendations
  2. Introduction
  3. Mutualisation within Health and Social Care
  4. High Potential Service Areas
  5. How to Replicate Mutual Models at Scale
  6. Conclusion and Appendices

As the evidence base about public service mutuals builds, it is becoming clear that they have a role to play within a diverse marketplace for public services. This is particularly true within health and social care, where over half of all existing mutuals operate following a decade of investment in the model.

This report, commissioned by DCMS, identifies the pockets of health and social care with the highest potential for staff-led models to be introduced. It also articulates successful approaches to support the creation of new and sustainable public service mutuals in the sector on a wide scale, making recommendations on which to replicate.

Mutuals in health and social care

Mutuals are an established service delivery model within the sector. Yet the overall number of mutuals (c.60 in England) remains modest.

The model is compatible with the current strategic objectives of the health and social care sector, and can help solve issues around the delivery of these objectives. Notably, they present a unique solution to uncertainties around the design of new governance models and avenues for staff participation in the formation of Primary Care Networks and integrated care systems, which are cornerstones of the NHS Long Term Plan.

One way mutuals can further this agenda is by giving an attractive option for Primary Care Networks looking to formalise their partnership arrangements by offering bottom-up involvement in decision-making. Another is by supporting multi-organisational governance and ensuring all views are represented, reinvigorating staff, enabling innovation and boosting productivity.

Unfortunately, the drive for further mutualisation has been watered down by other governmental priorities in recent years, leading to a general lack of awareness of the benefits of the model, and perceptions of lack of support by the mutual sector. Our report argues that the current health and social care landscape offers a unique opportunity to rekindle the mutual spark.


Our report identified five service areas that we believe display particular potential for mutualisation:

For each of these, we suggest how to replicate successful mutual models at scale, as well as for the sector in general.

Our research showed that each service area requires a different set of targeted intervention to open up the possibility of introducing large numbers of mutuals. For instance, developing a dedicated support package for primary care organisations is anticipated to deliver high impact if investment is provided in the short term.

In general, the formation of new mutuals in the health and social care sector will require a centralised effort from committed stakeholders across key government departments, with sponsorship from DCMS, DHSC and other parties. A complete list of priority actions is listed in at the start of the report.

Exemplar mutuals

A selection of mutuals who demonstrate remarkable growth and staff satisfaction are described in the companion case study report, which you can read here.


Health and social care is a sector in constant flux and with significant workforce challenges. Mutualisation offers a compelling response: increased productivity and savings, greater innovation and improved staff satisfaction and retention. Each of the recommendations outlined within the report is targeted to release these benefits so that the goal of a diverse marketplace of services is realised.

Want to know more about the work we do with Mutuals? Explore our Public Service Mutuals Hub.

Are you interested in mutualisation and want to find out more? Email tom.davis@baxendale.co.uk to start a conversation!

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