Is social franchising right for your intervention?

The terms social franchising and social licensing can have private sector connotations, causing concerns for health and social care teams about the potential commercialisation of the NHS.

Over the past six months, the International Centre for Social Franchising (ICSF) team, working with Health Foundation, has had hundreds of conversations about social franchising and licensing models, with everyone from patients to commissioners. This concern has been voiced a few times. We explain that these models do often involve a financial flow in the form of fees between the originator (the organisation that developed the innovation) and the local implementer – but the goal is sustaining impact, rather than making profit.

But the next question is often the same. The one size fits all approach of franchising may work for burgers, but how will it work in health and social care, where every context is different?

This is a common misconception of franchising – the idea that it provides a rigid structure, with little scope for autonomy or local adaptation. At ICSF we prefer to say ‘freedom within a framework’. Franchising and licensing work best when they provide frameworks: helping an organisation know what they must do to achieve impact, as well as what they can adapt for their context. For example, a framework might say that an intervention only works when specific members of a multidisciplinary team are involved. However, it would be possible to adapt the order in which patients see this team in each place.

It is this combination – harnessing the energy of local change makers, but building on a framework of what has already been proven and refined – that we believe give these models exciting potential to scale improvement within health and social care.

Through this project ICSF has held workshops with 15 different teams looking to scale up their proven health care intervention. We have identified four areas to consider if you are wondering whether social franchising may be right for you:

1. Understanding what you want to replicate

Designing a replication model must always start from understanding what it is you want to replicate. The core elements of a solution are the essential elements needed to deliver its impact.

If your intervention has only been implemented in one place, it can be hard to separate the core elements from contextual factors. A first step is often to test and refine your intervention in a number of locations before embarking on social franchising or licensing. This helps to understand what really makes your intervention work, as well as gather more evidence to prove the impact it is having.

2. Thinking about what you want to achieve through replication

All the workshop teams were united by the fact that their primary goal of replication was to improve health outcomes – they had developed something that works, and want others to be able to benefit from that too. But to understand if social franchising or licensing is the right approach, you have to interrogate the objectives behind this. For example:

These objectives will help you understand whether there is the need for a more structured and supportive ongoing relationship with local implementers, which is a key feature of social franchising.

• Will replication help you build the evidence base for the intervention to make the case for it to be adopted nationally?
• Will there be economies of scale, improving cost effectiveness of the intervention for all?
• Will fees help you to sustain a core team who can keep iterating and developing the intervention?

3. Making social franchising or licensing a win-win relationship

Social franchising and licensing will work best where a more structured and supportive relationship is of sufficient benefit to both the originator and the local implementer. You might ask:

What these benefits look like will be different for different interventions.

• How much training and support does an organisation require to effectively deliver the intervention?
• Will the support and training on offer be beneficial enough for them to follow your standards and pay a fee, rather than branching out on their own?

4. Putting a replication model into practice

So, you have decided that social franchising or licensing may be right for you. What next?

There is no one size fits all social franchise replication model. The model must be designed for the intervention and the organisation involved:

• How much initial support do local implementers need?
• How much ongoing support is needed?
• What are the central costs of supporting local implementers?
• What will the financial flows be between the two?
• Should local implementers be given an exclusive territory of operation?

Taking the time to create a robust design of your social franchise or license model upfront will help you recruit the right local implementers and plan the resources required. More information about some of the questions to ask can be found in ICSF’s Toolkit.

Martha Paren is Director of Health at the International Centre for Social Franchising