Like any recipe, it depends on the ingredients you have to hand and the ability of your chefs! However, at a time when the national attention moves towards Bake Offs and Masterchefs, I’m happy to reflect on our cookery challenge to date, and share our sweet moments and soggy bottoms!
We are four semi-rural practices on the western edge of the Peak District, separated by Cheshire’s rolling hills. All of us at Team BDP have similar reasons to change, and this was one of our most important steps. Our “burning platforms” were shared and agreed – overworked, unsupported, dropping standards, isolated, unhappy, increasing costs, dropping incomes, regulatory and contractual pressures, staff retention. Change was necessary, but what into? We needed a solution that incorporated our shared cultures and values, but addressed the slow erosion of the primary care model we had inherited.
Secondly, came the important ingredients of vision, aspiration and strong leadership – jointly defining a rosy picture of the future. A major factor was “taking back control” of our community teams. Through accepting the mantle of leadership we could ensure patient needs could be met by a team of not just practice staff, but other professionals in our region who, to date, passed like ships in the night, transacting but not collaborating with each other.
Thirdly, we required fairness and equality, and the CCG replaced our outdated and uneven Personal Medical Services/ and Enhanced Services contracts with a single stabilising contract that rewarded the extra work we put in day in, day out. They negotiated project management support for a small admin team to bring local care professionals together, and used the local “Caring Together” integration programme board to agree to delegate operational management of the local multi-disciplinary team members to our practices.
Lastly, the cherry on the cake? Branding, and the primary care home (PCH) label provides this. It legitimises an approach that cynics may see as experimental or lacking in evidence. It provides authenticity for sceptical CCG and Trust Managers, and gives doubting GPs hope that this is not some pipedream. The philosophy and approach of the NAPC’s PCH programme resonates with everything we are trying to achieve.
If I could add one more ingredient, and it’s one that I think will make this PCH become a show stopper, it would be a super-partnership to underpin this approach. A combined practice list of 33,000 across three villages provides us with efficiencies of scale to overcome all sorts of barriers created by separate practice accountabilities. Significant time and energy is being spent on investigating accountability, indemnity, estates and investment issues. A single partnership would eliminate a lot of issues, but would require significant support and resource. Investment to manage this underpinning merger, including accountancy, legal and management support, would have long lasting returns.
So there you have it. I’m sure I’ve missed some ingredients, but then again, you may be baking an entirely different PCH model. I for one expect this one to taste good ….when it’s finally out the oven!
Team BDP (Bollington, Poynton and Disley) PCH represents 4 practices in Cheshire, partnered with NHS East Cheshire Trust, Cheshire and Wirrral NHS partnership Trust, Cheshire East Council and Vernova Community Interest Company.
Dr Paul Bowen. GP, McIlvride medical practice, Poynton, and Chair, NHS Eastern Cheshire Clinical Commissioning Group (CCG).