Crikey! Winter happened! Again! Lucky we had a plan! Here in East Cheshire, we don’t usually get snow deep enough to build a snowman, let alone deny us access to local care services. But a winter plan is now as much a tradition as carving pumpkins, mince pies and new year fireworks.
I read, with a sense of bemusement, that our CCG’s planning schedule for 18/19 has a plan to finalise our “winter plan” in October. The sad reality is that it is both a necessity and a responsibility for all CCGs to have such a plan. This plan will then seek to understand all our providers’ winter plans, including general practices. I completely understand the need for such assurance, whether you be a regulator, commissioner, provider or member of the public. The fact that our NHS seems to fall over every winter has numerous underlying causes, but the absence of a winter plan is not, in my opinion, a major one. The reasons are far more complex and endemic, and historically include the focus on targets, short-term budgets, annual performance contracts, activity driven payments, disintegrated systems, and the inability for each system to consider the wider determinants of health when the thermometer starts to drop. Whilst flu jabs, cancelling ops and checking inhaler techniques all help, I feel a winter plan is a sticking plaster on a broken system.
For our Team BDP primary care home, next winter presents us with an opportunity to take full advantage of the benefits of multi-disciplinary working. This is because, by next winter, the four GP practices that sit within our PCH will have essentially merged. This is not just a technical merger through necessity or survival. This is a merger based on aspiration, ambition, optimism, and innovation. A single partnership, as a foundation for our primary care home, will allow us to plan for winter, summer, hell and high water (despite our land-locked position). If, as a partnership, we are responsible for the whole population of our “place” – the new buzz word in sustainability and transformation partnership circles – we can start to prioritise risk, plan workforce, promote wellbeing and engage our PCH staff to get the win-win needed for patients and our practices.
And, as a PCH, we don’t just have to plan for winter! Common health scenarios are far easier to plan for, and react to, if, as a place, you have autonomy, control and access to the skills of our PCH multidisciplinary team and have strong, formal GP networks or organisations supporting them. Say, for example, a celebrity announces they have prostate cancer – let’s arrange and promote a “know your prostate” talk at the town hall. The local psychogeriatrician goes off sick? Let’s mobilise our community psychiatric nurses and GPs with expertise in this area to support our care homes and practices. We’re expecting a heatwave, vaccination scare or scarlet fever outbreak? Let’s take a proactive approach to health education and preventative care rather than sitting back waiting to be overwhelmed by the next crisis.
It is my ambition, and belief, that in the future winter plans will be written not just to assure, but will be the responsibility of “place”, not organisation. They will not be about rationing, restricting, cancelling or delaying over winter, but instead be part of a long-term approach, to prioritise how local needs are met by teams with many different skills and resources across our community. The PCH model has the real potential to change the current way we do things with frontline staff developing the plan – not just for winter, but for all year round, and for the well-being of their whole place, whether it snows, shines or, as we find in the north west, is just a bit drizzly.
Dr Paul Bowen is Senior Partner of McIlvride Medical Practice in Poynton, Cheshire – part of the Team Bollington, Disley and Poynton (Team BDP) primary care home – and Chair of NHS Eastern Cheshire CCG.