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Wallsall network comes together in 60,000 patient super-practice
4 December 2018
Work on bringing just two practices together is set to result in a constituent super-practice in Walsall.
The Portland and Northgate practices had operated from the same purpose-built building for nearly 20 years, so when they began sharing a practice manager on an interim basis in 2016, there was a certain inevitability that the relationship would be consummated.
As practice manager Chris Blunt explains: “I was saying to both the GP partnership teams that they were not as different as they thought they were and that there were opportunities to work together.”
That started a process which saw Blunt and the GP partners securing funding from NHS England’s resilience programme, allowing them to commission support from PCC to boost collaboration between the practices which at that time had a combined list size of 18,000.
“I looked for support and advice to take the idea forward. When we secured £10,000 from NHS England we asked PCC to provide that support. The first piece of work they did was coming in with a diagnostic tool to talk to the GPs and staff to see how we could move it forward. That work also highlighted the need for the GPs to look at their skills beyond the clinical care of patients – to get better at clinical management. That was a very useful first step.”
The support was led by PCC primary care adviser Claire Deare, a former practice manager. One of the GPs, who had already completed the NHS England general practice improvement leader programme, took part in PCC’s Confident Leader programme for leadership development, while Blunt and a colleague attended a PCC workshop delivered by a lawyer from Hempsons solicitors. This provided information about prac tices’ options for working collaboratively, both formally and informally.
The same session was repeated locally in Walsall followed by a “drop-in clinic” by a law yer from Hempsons which allowed GPs from the two practices to discuss their
individual concerns around collaborative working.
“That gave us a sense of purpose and ideas, as well as highlighting the pitfalls others had fallen into and how to avoid them,” Blunt says.
Within a few months of embarking on the journey, Blunt and his colleagues realised that the two-practice collaboration could naturally extend to the small local GP federation of seven practices.
“I am managing director of the federation and I also t alk to the other practice managers so we began to think that maybe this wasn’t just for the two practices. We were already collaborating with the other prac tices because we had won CCG contracts so we began to consider what was happening with the federation. We invited the other member
practices to the myth- busting workshop.”
Less than a year on, five of the seven practices – including the two managed by Blunt – are conducting due diligence on the creation of a practice superpartnership
“We will have one legal entity covering five practices with a list size of around 60,00 0 but for the fir st t wo or three years we will keep five income and spending streams. We’ll gradually build the overarching par tnership that w ill provide services centrally to build up economies of scale .”
The five practices have secured an additional £20,00 0 from NHS England to support that work.
Blunt says the practices are making sure that GPs are involved all the way. “A lot of this work tends to be management driven because GPs are busy with patients but we felt it was
very important to w iden the discussion to ensure it was som ething GPs want themselves. That’s why for three to four months GPs from the five prac tices met every fortnight. It gave them a chance to discuss with each other w hat a superpartnership would mean for things like property when some practices rent their premises and others own theirs.
“After events that PCC facilitated they decided that yes, we could work together.” For the Northgate and Portland practices, that means pressing ahead with collaboration and potential new partnership models on two fronts simultaneously. Blunt says: “The partners are talking about whether to form one partnership from the two practices or wait for the super-partnership.
“The two practices are sharing quite a lot of services – particularly the management team. We also share an anticoagulation nurse and nurses from one practice help out the other practice on an ad hoc basis .”
Blunt continues: “ We can see areas of scaling up out side our traditional four walls. We have the confidence to do that because Claire has told us in the workshops that practices have tried something similar and it has worked for them.”
They share all training ac tivity – reducing costs and allowing the two teams to learn from each other. Blunt says it’s also important to keep the practices’ patient participant groups informed of progress and plans.
The two teams of GP partners meet monthly, as well as maintaining their individual practice partners’ meetings.
So far, GP concerns ab out any possible negative impact on patient care have been eased by patient survey results showing that nearly 100% of each practice’s patients rate the ser vices as good or better.
Blunt highlights another challenge that looked a little daunting back in 2017, when four of the practices’ nine partners were due to retire within three years.
“That posed problems for succession planning but also raised questions about decision -making on collaboration. The four partners have been brilliant though and said they will advise and support their colleagues but that the remaining five partners must make the big decisions.”
Meanwhile, the five practices have submitted a bid to run a prescribing hub for the CCG and are looking at developing a centralised hub for scanning and summarising patient records and the referrals work undertaken by medical secretaries.
As Blunt says: “The CCG is keen to see people scaling up and that seems to be the message from on high, so we’ll keep on making progress."
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