13 / 07 / 2020
Community services and general practice in Derbyshire are on a journey towards integration, which is heading in a positive direction. Relationships are good, which brings efficiency benefits in itself. However, system leaders agree there is still a long way to go. With every forward step, more obstacles are revealed and must be navigated.
What the organisations did
Significant time and energy has been invested into developing positive relationships between general practices, community services, social care and the voluntary sector. This has involved several initiatives, starting with CCG development, continuing through ‘place’ and now with PCNs. The organisational development programme, Leading Across Boundaries, from the East Midlands Leadership Academy, has also played a significant part in starting that cross-organisational conversation. Building open and honest relationships has been a core part in the success of primary and community care collaboration to date, and provided a firm foundation on which to develop truly integrated services.
More recently, GP practices in Derbyshire have created an informal GP alliance that enables a unified, constructive GP voice in system conversations. In parallel, Derbyshire Community Health Services (DCHS) NHS Foundation Trust has shown its commitment to integrating with general practice by appointing a clinical director for integration, who is an ex-GP with the credibility to lead the integration work, provide honest brokerage and challenge both the community trust and general practice colleagues to work together in new ways.
Results and outcomes
Local leaders across community and primary care have built mutual understanding and empathy across the system. The chief executive of DCHS invited GP providers to be part of the DCHS board development session, and in turn she attended the GP alliance development session, thus building an empathy and understanding of each part of the system. These relationships are now at a point where both community and primary care colleagues can constructively challenge each other without questioning the intentions or motives for doing this, other than to move the integration and transformation journey forwards.
During the COVID-19 pandemic these relationships have proven invaluable, allowing mutual aid and rapid resolution of problems and misunderstandings through direct conversations. The availability of PCN clinical directors to broker conversations between community teams and their local GP colleagues has been a great facilitator. In previous times, similar issues would have been escalated via the CCG, taking weeks to resolve and damaging relationships. Once again, local leaders role modelled successful partnership working by agreeing a pragmatic way forward to continue weekly multidisciplinary team meetings during the COVID-19 response.
There are a number of specific projects where groups of GP practices are working together with DCHS to improve outcomes for patients by removing duplication across primary and community services. Examples include the Erewash and Chesterfield frailty teams, the Primary Care Plus Acute Frailty Home Visiting Service and the Derby City South PCN care homes project.
The system leaders in Derbyshire continue to evolve the partnership model, recognising that they won’t always get it right first time but will continue to work together to deliver better care for patients and a better working environment for staff.