A famous peanut-based chocolate bar has the obvious warning – “contains nuts”. There’s also an inconvenient and obvious reality facing the architects of a more integrated NHS – partnerships.
Warning: They contain partners! Old ones. New ones. Cynical ones. Innovative ones.
Fortunately, in most areas, they work together to form the front line of the NHS. They contain a self-employed sector unique to this incredibly important breakwater and filter for the rest of the system.
Love the independent contractor model or not, this partnership model is often ill understood by some, and changing the way partnerships operate, requiring them to act, feel and behave differently is not easily done. Every partner has his or her own motivations, priorities and values, and therefore the desire to form strong GP networks as a foundation for integration requires ownership and commitment from, and mutual benefit to, all partners in all partnerships.
As a GP and a partner I have many carrots and sticks encouraging me to collaborate with other local GP practices: our local place-based ICP and STP backed integration programme, an active GP federation, a new primary care network (PCN) contract, the General Practice Forward View and the “pots” of cash attached to it, and an established primary care home (PCH) programme. However, I have lots of reasons not to, including personal autonomy, financial risk, fear of change, and contractual uncertainty.
So what is the difference between a primary care home and a primary care network? I think many will think they are one and the same. There are plenty of GPs and commissioning managers who unfortunately do not truly understand, or have not grasped the benefits of, the PCH movement. They either look to PCNs as the answer to integration, or just another contractual distraction.
However, for those of us who have been involved in primary care homes, and are benefiting from the relationships the programme has built up between practices and the wider multidisciplinary team, we see the PCN contract as helpful wind in our sails.
A few years ago, when a local GP from one of our practices started investigating the formation of our PCH, it was met with the usual scepticism (and occasional cynicism) from the rest of us within our network. We’d heard it all before, from our CCG and its ambitious integration programme, to the myriad of consultancy company’s bestowing the benefits of “more joined up care”.
However, we soon came to realise the PCH programme was different.
This was not a top down, pie in the sky approach. It made sense. And the trust and understanding that built up between the local GPs in our local four practices eventually led last month to the formation of a single, merged super-partnership on the footprint of our PCH.
Still operating out of four surgeries, our new Middlewood partnership contains many types of partners. However, I believe the PCH was the catalyst to form a more sustainable, innovative and future proof model of general practice at scale. We’re rolling out a new model of care, collaborating with our health and social care partners as a single GP organisation, and the PCN funding, whilst not enough to truly integrate community care, is going some way to justify and promote a new way of working within our community.
How the CCGs and the centre enforce and evolve the PCN contract, from building stronger GP networks and developing the foundations of wider integrated teams, will depend on their understanding of the cultures and psychology of partnerships. If partnerships are truly going to change, they need experts to lead and make that happen, and those experts will only come from one place, our primary care partnerships themselves.
The primary care home (PCH) programme is the original primary care network model developed by the National Association of Primary Care (NAPC). Click here for more information about the PCH programme.
Dr Paul Bowen is a GP and Medical Director of the Middlewood Partnership, Cheshire. He is a member of Team Bollington, Disley and Poynton (Team BDP) Primary Care Home and will be speaking in NAPC’s Primary Care Zone at Confed19 on 20 June at 1pm in the session: Primary care homes – advanced primary care networks: impact and lessons learnt session. Click here for more information.