From a General Practice point of view, we are going through one of the most significant changes to how we work and how GPs are funded for some considerable time. The last major change to the GP contract was 15 years ago, and the current changes are arguably more wide-ranging. They are, however, exciting! If you were to ask me what we have been trying to achieve in the last 6 years since the advent of Clinical Commissioning Groups, then I would say we are closer to achieving it now than ever before, and the new GP contract should help us to get it over the line.
It’s all about integrated care. It’s about health and care organisations working together to improve things for the people of the area. It’s about bottom-up transformation of care. It’s about bringing organisations together to ensure that people are not falling through the gaps between them, and about changing the services so that they work better, more efficiently and for the whole person.
If you read through my back catalogue of blogs you will find me talking about integrated care. You will get a feel for how important I think this is. Too long we have been working in organisational silos, and organisations have been planning services around the needs of the organisation, rather than the needs of the patient. We have been stuck in a financial model forcing a split between purchaser and provider, with GPs often feeling stuck somewhere in the middle. It has at times felt less about patients and more about services.
Moving towards a model of integration will help with this. We need to develop communities of care embedded within local areas. These communities can together decide on what they want to focus on, and do so in a truly holistic way. Providers need to do this in collaboration with patients and other key players within the town, village, borough or however else you define your local community. This will mean working with all the health organisations (GPs, Community Services, Mental Health Services, Hospitals) as well as social care, Public Heath and then voluntary sector. We also need to include other public services such police, fire, housing, education, leisure and more. We need to empower our local communities to consider how they can help themselves, and move away from medical models where we look to ‘fix’ problems for people, rather than helping everyone to help everyone else.
The new GP contract starts to embed some of this. It encourages GP practices to come together to create Primary Care Networks (PCNs). Practices have been left to decide for themselves who will be in their PCN, with some guidelines to ensure PCNs are not too big, or too small, and also making sure the whole population is covered. I think these new, developing PCNs will, over time, develop into much more than just alliances between practices. I think they will grow into true Care Communities involving all of the organisations I listed previously. I think they will start to tap into the resources that already exist within those communities and will be the catalyst for community engagement and a new way of approaching health and care.
As a GP myself I see this as a wonderful opportunity for local clinical leaders to emerge. GPs have vision and passion to do the right things for their patients. They see the struggles that they have, and feel them deeply. They want better services that work for their patients, that are accessible for their patients and that are efficient and sustainable for their patients. They can capture the imaginations of their fellow GPs and health care professionals and start to lead a movement of change in their local area.
The new GP contract puts some of the structure in place that will allow this to happen. What we cannot contract for, however, are the relationships, the vision, the passion and the leadership. It is time for community, social care and primary care service professionals to step up into this new arena. We need to communicate the vision to our colleagues and inspire a change in how we work. We need to encourage, empower and enable the patient voice to be heard, stimulating citizen leadership and true community ownership.
These are exciting times.
The challenge is there for us to approach. Current senior leaders need to understand the changing health and care environment and support the newly emerging structures. They will be different kinds of structures, less about individual organisations and more about networks, collaborations and relationships.
My challenge to all reading this is for you to take the time to understand your place and role within your local system, and to do what you can to support it’s development.
Dr Jonathan is a GP at Swanlow Surgery in Winsford, Cheshire, and Chair of NHS Vale Royal Clinical Commissioning Group.
Do you have a question for Jonathan? Find him on Twitter @DrJonGriffiths