More time and flexibility needed for meaningful transformation

More time and flexibility needed for meaningful transformation

Dr Stewart Smith comments on the DES draft specifications – he is GP Partner and Medical Director at NAPC’s current Primary Care Home of the Year – St Austell Healthcare

As a primary care home (PCH) rapid test-site, St Austell Healthcare has spent the last five years working to develop relationships with colleagues from across our local system and moving towards a more integrated model of care, underpinned by the principles of the PCH programme. As a result, we have moved from near service failure five years ago to being awarded the NAPC’s PCH of the Year award in 2019.

Like many colleagues from across the PCH spectrum, developing strong relationships with colleagues from different organisations has been the corner-stone of our transformation. For example: working more closely with our district nurses has resulted in both St Austell Healthcare and our community nursing teams being able to resolve the workforce crisis and unsustainable rising vacancies of five years ago to becoming the fully staffed team we have now.

It is important to note that building trust, making changes and seeing results takes time. Transformation needs to be co-produced by operational teams. Our successes have evolved over time by working together and identifying areas of need (and strength) bespoke to our population and the people who care for them. When we have tried to enforce change or been too eager for results, then projects have stalled and failed, despite best intentions.

While we support the principles of integration and proactive care that the draft DES specifications are built on, we have concerns over the intended speed of implementation and their prescriptive nature. Based on our PCH experience, the intended DES requires degrees of primary care network (PCN) and system maturity that, for most, are completely unrealistic at this stage of the journey.

It’s clear to me that PCNs across the country will have different priorities and should be allowed to work on these, rather than being confined by rigid service specifications. After five years, St Austell Healthcare now feels ready to help system partners reduce pressure elsewhere, provided there is an appropriate shift in resources. The DES spec does not provide for that shift in resources and does not, in our view, effectively meet the needs of our community.

The pressures on systems and primary care are well documented, we have seen around a 12 percent rise in demand for routine appointments at St Austell Healthcare in the last two years alone. Our local system is under unprecedented pressure. The successful delivery of the PCN contract is critical to our future but we need to be honest and realistic about the time frame to deliver this.

Our experiences show that transformation takes years and needs to grow organically at an operational level, not be prescribed to us from boardrooms. There is enthusiasm for the PCN model amongst our local system and my CD colleagues, but, unfortunately, the draft DES specifications have dampened the mood at a time when many can ill-afford a drop in morale.

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