Interview: Improving care should motivate practices to work together, says NHS London GP

GP practices need to collaborate to build sustainable general practice and should not be motivated primarily by financial incentives, says senior NHS England London GP Dr Jonty Heaversedge. He talks to GPonline about how he hopes to help.

NHS England’s new medical director for primary care and digital transformation Dr Jonty Heaversedge is described in the statement announcing his appointment as a ‘well-known and respected GP’. With several years' experience in the media, including presenting BBC television shows Street Doctor, The Smokehouse and Lifegivers, he is a familiar face. And after four years in the leadership of Southwark CCG, which he now chairs, Dr Heaversedge will be well known in NHS leadership circles in the capital.

Speaking exclusively to GPonline before he takes up his new job in August, Dr Heaversedge is ‘excited’ by the two-pronged focus of the role - the ‘digital agenda’ as ‘key enabler’ for transforming primary care and making it sustainable for the future.

The primary care element of the role is focused on transformation, particularly around collaboration and implementing the GP Forward View and keeping general practice at the heart of community-based care in the capital.

Read more: GP collaboration 'can end GP crisis'

Dr Heaversedge is keen to make clear that he sees the position as one in which he will act as a facilitator: supporting local clinicians and leaderships in London’s 1,400 practices, 32 CCGs and five sustainability and transformation partnerships (STP), where most of the transformation is being developed and implemented.

‘The role is really to try to support those clinicians already involved in leading change within their local areas,' he says, ‘to ensure they're getting the support they need and they're enabled to really start to think quite differently about the way in which they deliver services to local populations.’

The digital transformation prong, he explains, is recognition of the importance of using information technologies to transform and improve services. GPs have always been on the cutting edge of technological innovation, he says, as evidenced by the move to computerised records.

As a practising GP he says he feels the frustration that many feel with the fragmentation of the NHS when trying to communicate and share information with colleagues in community or acute services. But technology provides the basis for greater collaboration among practices and across the NHS.

Technology can help practices suffering the burdens of increasing demand, says Dr Heaversedge, create efficiencies by helping to discern which patients should see a GP and which should see someone else in the team, help to improve practice processes and can empower patients to manage their own care.

Working at scale

‘I think we can kind of look forward to a much more collaborative, multidisciplinary approach to delivering care in communities with general practice at the heart of that,' he says. ‘But, I think being quite innovative in the way that it works, to still deliver very personalised care for individuals but equally to be working at greater scale and delivering care quite differently to populations.’

Dr Heaversedge says his regional leadership role at NHS England will involve helping and encouraging the spread of learning and innovation across local areas.

‘In the last two weeks I've had people come and talk to me, all of whom have medical training, about new apps that they've got, on how to better identify cancer in patients, how to prescribe antibiotics more appropriately, how to support people to manage their own asthma, even a CBT app on how to quit smoking.

‘So we've got this incredible kind of imagination and the risk with that of course is that we then get a kind of plethora of different sorts of innovations happening in different parts of London,' he says.

What is needed is someone at a London level to help spread that innovation across the region.

GPs, says Dr Heaversedge, are right to have concerns over data security when considering IT integration and to recognise their role in that. He says his role will involve talking to GPs to understand the concerns, to provide reassurances about the safeguards, and where necessary making sure the correct safeguards are in place. ‘I do think that it is as important for us to be sharing data to improve the quality of care and the safety of care that patients receive as it is to be protecting data,' he says.

GP industrial action

Just days after the BMA posted ballots to practices across England for industrial action over what it says is the failure of the GP Forward View to deliver resources necessary to sustain the service, Dr Heaversedge says implementation of the £2.4bn support and reform package is making ‘good progress’ in the capital.

Despite complaints the money is inadequate, difficult to access and often has too many strings attached, Dr Heaversedge says funding is increasing although will ‘continue to be a challenge’.

Access is improving, he says, with London on track to have 97% of patients with 8am to 8pm, seven-day GP access by the end of the year, and 91% of patients served by a practice working in some form of collaborative arrangement. It is that collaboration by practices to transform services, he says, which is the only solution to the pressures GPs face at the moment.

Whatever the outcome of the industrial action ballot, the only way to relieve the very real pressures GPs face, he says, is working collectively to provide services differently. ‘What I don't want us to do as a profession is to sort of batten down the hatches and just try to cut our cloth,' he adds.

The battle for recognition of the importance of general practice has been won, says Dr Heaversedge. ‘I don't think I've got to go out and convince anybody how important general practice is to the sustainability of the health system as a whole.’

‘The challenge then is how do we ensure that we have the resources and the support in place to enable us to then move towards a future that as I say I think involves much greater collaboration not just with GPs but with other teams in the community, taking a real leadership role because they understand more than anyone how to ensure their local populations receive the care that they need.’

GP funding

In March NHS England announced it would offer financial incentives to encourage every practice in the country to join a primary care network of at least 30,000 to 50,000 patients over the next two years.

Dr Heaversedge says he has ‘no idea’ whether there are plans in London to create a financial incentive. But motivation for collaboration, he says, should ‘not simply be to to achieve a financial incentive’. Collaboration should happen because it is better for patient care because it means services are more adaptable and flexible, and better for staff because it creates better career opportunities, and better for the whole system because it creates sustainability.

‘From my perspective’, he adds, ‘I'd want to be having that conversation with GPs about some of the value in working together rather than necessarily focussing on financial incentives.’

Dr Heaversedge acknowledges that the collaboration landscape at the moment is patchy, with some federations taking on service provision, while others ‘still feel slightly more shaky’. ‘But I think that that's a kind of inevitable part of such a significant change’, he says. ‘I don't think we should underestimate the kind of change that we're seeing in the general practice landscape.’

His role will be to help share good practice across CCGs to encourage them to make the kinds of commissioning decisions locally to enable strong federations with local provider contracts enabling working-at-scale.

The ever greater focus on at-scale working, says Dr Heaversedge, shouldn’t be seen as a threat to smaller and single-handed practices, of which London has a relatively high proportion. The challenge for GPs at those practices is around working in isolation, he says, and that can be improved with collaboration, without threatening the status of individual practices.

‘My focus would be more on trying to ensure that those practitioners in London who feel that they are working in isolation, and often therefore feel quite overwhelmed by the demands that there are on them, are able to see the benefits of working with neighbouring practices and colleagues to think about how care can be delivered differently.’

And that has already happened successfully, he says, with the roll-out of extended access, with smaller practices working with others to deliver it.

Dr Heaversedge says he knows the challenges facing GPs are real, and that is recognised by NHS England. ‘But at the same time I think general practice has always led the way and has a huge amount going for it. It's so vital to the health system and I don't hear anyone disagreeing with that. We have made great progress, I really don't hear anybody disagreeing with that. How we do it is much more challenging. And that's where I hope that I can be more helpful.’

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