This article by William Greenwood, PCC governing body member and chief executive of Cheshire LMC, reviews recent NHS England documents, considers the potential future for single neighbourhood providers, multi-neighbourhood providers and recommends that practices start to develop collaborative arrangements now to ensure they are ready and able to grasp future opportunities enabling general practice to get in the driving seat for future transformation of care in communities.
Over the course of the last few months, we have seen a drip feed of guidance from NHS England regarding neighbourhoods and strategic commissioning. The recent consultation document on single neighbourhood providers (SNP) and multi-neighbourhood providers (MNP) underlining the potential future direction.
The ambition has emerged for GP led collaboratives (which may be collaboratives of MNPs or a single MNP) as a provider-led vehicle that can support the strategic commissioning of general practice. I believe (of course) there is significant potential in this approach to deliver the much talked about ‘transformation’ of care in communities.
The integrated care board (ICB) should define the desired clinical, financial, and operational outcomes, while the provider sector takes responsibility for designing, implementing, and refining the solutions needed to achieve them. This aligns expertise with responsibility and recognises that, given the ICB’s more strategic role and reduced operational capacity, much of the transformation capability now sits within general practice, and collaborations with other providers at community level.
Trust led integrated healthcare organisations (IHOs) are also on the horizon, but there is an opportunity now for GP collaborations to grasp and shape the future. They may share footprints with MNPs in some areas. It is likely there may be multiple MNPs that include different groups of SNPs/PCNs for different purposes across single ICBs. Some may match collaborative footprints.
For this model to succeed, seven principles will be essential:
- Outcome-focused commissioning – the ICBs should define outcomes rather than prescribe delivery.
- Provider autonomy – the collaboratives should have sufficient freedom to innovate and determine how agreed objectives are achieved.
- Appropriate investment and infrastructure – if the collaboratives are expected to lead on these projects and initiatives, they must be supported by appropriate movement of resourcing. This includes funded GP leadership development support, executive and programme management capacity, project management, analytical, financial, and technical support. Without this infrastructure, the collaboratives/MNPs will struggle to fulfil their potential and deliver sustainable change. It is noted that there is a current procurement relating to GP training hubs that collaboratives/MNPs/federations may be interested in.
- Subsidiarity – work should be delivered at the most appropriate level. ICB-wide initiatives (such as major digital programmes) can be led centrally, while service redesign should be delegated to place level, PCNs and emerging MNP footprints where local solutions are required.
- Clear governance – the collaboratives should have defined terms of reference that distinguish their role from, for example, the local LMC and other representative groups.
- Strong engagement – meaningful engagement with practices will be essential if the collaboratives are to develop credible, deliverable solutions. Again, this will require a shift in available resources.
- Defined relationship with the local medical committee (LMC) and other local representative committees (LRCs). The collaboratives and MNPs should focus on service design and transformation, with the LMC retaining its statutory role in representation and contractual negotiation once service specifications have been developed.
I also believe that local GP collaboratives (some of which may be larger MNPs) will be important. Whilst an ICB-wide collaborative can oversee strategic programmes, much of the innovation, transformation and service redesign needed to deliver neighbourhood care and the left shift into primary care will need to be developed at place and MNP level, reflecting local population needs and provider capability, as well as local assets. Health and Wellbeing Boards can play a key part in this development.
There is a genuine opportunity to create a collaborative model that combines clear strategic commissioning with provider-led innovation. If at a ICB and local level we can agree the underlying principles, governance, appropriate resourcing, and respective responsibilities at the outset, I believe we have the foundations for a model that could deliver real benefits for patients, practices and the wider health and social care system.
Let’s not waste another 20 years waiting for this opportunity to come round again.
Author: William Greenwood, PCC Governing Body Member and chief executive of Cheshire Local Medical Committee.
PCC is supporting PCNs, neighbourhoods, federations and collaboratives to consider opportunities and position themselves well for the opportunities ahead. Contact enquiries@pcc-cic.org.uk.
PCC working with the Good Governance Institute has recently published an article offering tips for practices working together https://pcc-cic.org.uk/five-questions-every-primary-care-leader-should-be-asking-about-neighbourhood-health/
