The long-term benefits of working at scale
As the system continues to battle COVID-19 and the care backlog, federations more than ever need to do all we can to support our practices and primary care networks (PCNs) to deliver care to patients, writes Dr Andy Hilton.
In such a challenging time it’s hard not to focus on the immediate benefits of at scale delivery to manage the current crisis and add system resilience. However, across the country, federations are pushing forwards with transformational work that will improve patient care in the longer term.
As vice-chair of the NHS Confederation’s Primary Care Federation Network I have the privilege of meeting with primary care members across the country and learning how they use their local knowledge, scale and partnerships to strengthen primary cares offer to patients and systems. You can read about many of these services in the federation directory of services. These examples have solidified my belief that there needs to be greater national and system recognition for delivery at scale within primary care and a future onus on integrated care systems (ICSs) to proactively develop their at-scale primary care provider infrastructure.
…how important scale of delivery can be to ensure the right care, at the right time, in the right place
While unlike PCNs, that are mandated in a national contract, there is not universal coverage of federations, however, our membership stretches to well over a hundred federations across the country, all rooted in the values of the NHS and investing in patient care. Where federations do not exist, we are already seeing that networks of networks are developing as PCNs recognise the need to come together for some functions at a scale greater than 30-50k. There is real value in building something that works right locally, but as systems evolve, they need to be take advantage of different layers of scale within primary care.
Today, I want to share with you some of the work I am personally proud of within Primary Care Sheffield. We are just one federation in one ICS, but I truly believe we are making a difference to our patients and adding value to our offer as a system. We know that, through the Claire Fuller Stocktake, ICS leaders will be provided with guidance on how to support primary care to deliver patient care and improve integration. I hope, that throughout the engagement process our network and my colleagues across primary care can highlight just how important scale of delivery can be to ensure the right care, at the right time, in the right place.
Primary Care Sheffield
Responding to pressures
Over what is proving to be an incredibly busy winter we have increased capacity and expanded the skill mix in our hot and cold extended access hubs, reducing pressure on practices and freeing them to accelerate the booster vaccine campaign. We’ve mobilised a rapid response home visiting service that domiciliary carers can phone directly without needing to go directly through to their registered GP. Rapid assessment by a team of paramedics and advance nurse practioners with GP oversight is helping to reduce admissions to hospital and rapidly responds to patient need.
The relentless pressure on practices throughout the pandemic has resulted in some of them struggling. As an at scale provider we have been able to rapidly step in with a range of support offers that have enabled them to continue to provide care.
Transforming services
The pandemic has created a huge elective caseload and on behalf of our PCNs, we are working with Sheffield Teaching Hospitals on an ambitious transformation programme for elective pathways which includes peer review and referral support across ten specialties, the development of advice and guidance and enhanced triage, community diagnostics and end to end pathway redesign for two specialities.
...we are also receiving positive feedback from professionals in both primary and secondary care
We have also developed a primary care mental health transformation programme that is driving integration through partnership working with our local mental health provider, Sheffield Health and Social Care trust and with the local voluntary sector through Mind. As we expand this programme across more PCNs in the city, not only are we seeing improved service user experience and more equitable access for those in deprived communities, we are also receiving positive feedback from professionals in both primary and secondary care.
Building primary care leadership
Finally, our leadership and coordination role has proved vital both within place in Sheffield’s Health and Care Partnership and also within the South Yorkshire ICS where we have been instrumental in the establishment of a primary care provider collaborative. Our internal governance with a subcommittee of our 15 PCNs means we can be the conduit between local partners and wider system and the PCNs and practices.
The collective impact of these various streams of work is to not only add resilience to primary care and the system in the here and now but also to shape future services so that they remain sustainable and responsive to the people they serve.
Dr Andy Hilton is the vice-chair of the Primary Care Federation Network at NHS Confederation, a GP partner in Sheffield and chief executive of Primary Care Sheffield. You can follow in on Twitter @AndyHilton74
