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Viewpoint - London general practices can overcome challenges by working together

Dr Jonty Heaversedge is Medical Director for Primary Care and Digital Transformation (London Region) NHS England and a GP in Southwark. Here he explains why he believes “The Next Steps to the Strategic Commissioning Framework” (SCF Next Steps) is a vision for strengthening general practice collaboration across London, what it means to work at larger scale and the potential benefits for practice teams and all Londoners.

I have been a GP in South East London since qualifying from the University of London 20 years ago. Today I remain as passionate about general practice as I when I first qualified, I see the value it brings to the health and social care system, and the need to ensure that we have a high quality, sustainable primary care service at the heart of integrated care systems as they emerge across London.

Since the publication of the Strategic Commissioning Framework (SCF) for primary care in London three years ago, the pace of change in general practice across the Capital has picked up significantly. Despite the enormous pressure we are all under, I have seen GPs and practice teams embracing new ways of working together. There is a cultural revolution underway, moving away from an era of competition and towards a future of collaboration.

As I look across the health and care system in my local borough of Southwark, it is general practice leading the way transforming how care is provided  to our residents – and this is true of every London borough. But as GPs, we see the challenges facing our patients and it is clear that more needs to be done. Our ambition in the SCF is to encourage practices to work together at scale, ensuring we protect the core values of general practice whilst working collectively to create new opportunities for staff and patients, and more sustainable integrated systems of care with local partners.

It is widely recognised that collaborating at scale is vital to ensuring a sustainable future.  In Southwark, as in most other parts of London, this is what has enabled us to provide additional appointments so patients can now be seen in one of our extended hour’s hubs at evenings and weekends. London has led the country in developing this enhanced service for our residents. And there has been other progress with more GPs in training, a broader skill mix in our primary care workforce, and greater use of digital technology.

Much of this has been achieved through practices working together and almost every practice in London is now a part of a larger scale general practice organisation that mainly take the form of borough-based federations. Our intention in the SCF is not to try and prescribe what form these arrangements should take, but rather demonstrate the very real benefits that can be realised through collaboration. We believe that these larger scale arrangements have an important role in the future by developing and training a broad workforce, creating shared operational systems and quality improvement approaches as well as providing a strong voice for general practice as part of our five Sustainability and Transformation Partnerships (STPs), and in time new Integrated Care Systems (ICSs).

Across London we are seeing practices coming together with other community providers and the voluntary sector forming Primary Care Networks (PCNs), serving local populations of 30-50,000. The vision is to deliver multi-disciplinary, team-based care for those with enduring, complex health and care needs – the most common example of this approach is the NAPC Primary Care Home model. I would like to see every practice in London as part of both a LGPO and a PCN – finding both greater efficiency and effectiveness through collaboration.

I recognise that practices across London are all at different stages of collaboration, and this is why the Primary Care Clinical Cabinet for London has written the SCF Next Steps to provide the information, evidence, and support that practices need to deepen their partnerships with other practices and the local health and care system, no matter what stage of the journey they are on. Our commitment is to provide the resources they require to develop collaborative arrangements. By working together at greater scale, general practice can be both small and big; it can keep providing patients with personalised, whole-person care at practice and PCN level, but it can also provide strategic support, leadership and a strong voice through larger-scale general practice organisations.

Most importantly from my perspective, it is the opportunity to bring joy back into general practice for staff. Greater collaboration can enable individuals to reconnect with their personal motivation, offering a more fulfilled working life allowing sharing expertise, working in a collaborative environment, developing skills, and constantly learning – where systems and processes are always improving, and the burden of administration is reducing. 

We know that having happier staff will also ensure patients get the best possible care, and closer collaboration between practices and with other providers of health and social care will also ensure our population receives more integrated, accessible care – delivered by a multi-disciplinary team with the combined skills to provide comprehensive, personal care which meets all of their needs ensuring they receive the right care at the right time. 

If you require further support or additional information about The Next Steps to the Strategic Commissioning Framework, please contact england.londonprimarycaretransformation@nhs.net.

Last updated : 27 Nov 2018

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