Professional relationships, built slowly over time, based on trust and understanding, are vital to integrated working. It requires a different style of leadership to the traditional hierarchical model that’s existed in the NHS since its conception.
For primary care networks (PCNs) to thrive, and for integrated provision to work effectively, leadership needs to be about listening, about being compassionate, and about empowering others to lead and to bring about the changes that they themselves want to see happen.
When relationships are good, one of the great strengths of integrated provision at a local level is the ability to react quickly to changing situations, without the need for endless meetings or contractual arrangements being argued over.
So when COVID-19 arrived, the first thing the GPs in our three practices agreed was to support each other and provide cross cover if any practice lost significant numbers of staff and were unable to manage their own patients. We also quickly planned how a 'hot hub' would work in the town.
Thankfully neither of these initiatives have been needed as our practices have not been overwhelmed. The agreements and plans do however remain in place. Money has never been discussed.
The initial pressure was on our community nursing team and on community pharmacy. As soon as QOF was suspended, the freed-up GP practice nurse resource from cancelled long-term conditions clinics was offered to our community nursing team. Freed up clinical pharmacist time was used to support community pharmacy.
This enabled both of these vital services to continue to meet the increasing needs of our residents. When it became clear that local care homes were starting to experience increasing numbers of COVID-19-positive residents, then our focus became to support them.
Allied healthcare staff
Our social prescribers provided a vital link between the outside world and those patients on the shielded list and others self-isolating. Regular contact was established and continued throughout lockdown.
They are still working on a one-to-one basis with individual residents who are now nervous about leaving their homes after isolation. They are also helping group activities to start again outdoors.
Our extended leadership group was expanded to include our food banks, becoming known as Fleetwood Together. Before the pandemic around 300 residents were receiving support. This has now risen to over 1,200 and will increase.
Our top priority in the next year is to reconnect to our community, listening to residents about the health and care services they envisage. Digital will be part of that with continued use of telephone and video consultations, as well as technology enabled self-care.
However, the human face of healthcare, the building of lasting relationships between clinicians and patients is also something that matters.
Undoubtedly health inequalities will widen. I believe the place to tackle inequalities is at the PCN level. This requires resident involvement, as well as a focus on the wider determinants of health such as housing, education and food.
Fleetwood PCN will also be paying attention to addressing health inequalities in our community. We can only do this by working together with our residents and our relevant stakeholders in schools, housing associations, food banks, local authority, local businesses and many others.
The full potential of PCNs is much more than the better management of illness. They are also part of improving the health of whole communities, and of bringing about a fairer society.
PCNs will need help from NHS England and local commissioners to reach their full potential to address the needs of their own communities. This includes support for a shift in leadership culture to one that actively builds relationships. Together we can make a difference.
- Dr Mark Spencer is co-chair of the NHS Confederations PCN Network and clinical director of Fleetwood PCN in Lancashire