– Vertical Integration, PCNs and Leadership Advice.
Primary care plays a vital role in the NHS, yet it often goes unnoticed and under-appreciated. As the first point of contact for patients, primary care clinicians manage a wide range of health issues and coordinate care with specialists and other key community services.
Since 2019, initiatives such as Primary Care Networks (PCNs) have emerged to elevate the status and support the growth of primary care services, aligning with the objectives outlined in the NHS Long-term Plan.
In this article, I’ll share insights from my conversation with Dr. Mona Sidhu, Primary Care Medical Director for Black Country ICB, and Dr. Bukola Olomolaiye, a GP at Coalway Road Surgery and Deputy Clinical Director at the Royal Wolverhampton NHS Trust Primary Care Network. We’ll explore their PCNs’ organisational dynamics, cultural ethos, and leadership style, examining the transformative potential of a primary care career.
Understanding the Royal Wolverhampton NHS Trust PCN Structure
Dr. Olomolaiye explained how their unique structure operates. Primary care is delivered mainly through the GMS (General Medical Services) contract between the NHS Commissioning Board and GP Practice Partners.
In their vertical integration model, this contractual responsibility is delegated from the GMS contract holders to the acute trust. The acute trust employs both GMS contract holders and other primary care staff, providing comprehensive human resources management for the primary care surgeries. The Royal Wolverhampton NHS Trust PCN is one of over two dozen PCNs in the Black Country ICB.
The PCN operates within the primary care division of the Royal Wolverhampton NHS Trust, working collaboratively with community teams, public health sectors, voluntary organisations, and patient groups to create stronger connections across the healthcare landscape. This approach aims to provide holistic patient care under the Network Contract DES.
Empowering Community Engagement and Healthcare Accessibility
Central to the PCN’s mission is empowering the primary care team to enhance healthcare accessibility within the community. Through targeted vaccination programs and initiatives promoting equality and diversity, primary care services are brought closer to residents’ doorsteps.
Community teams facilitate home visits and proactive health promotion activities, using social media to communicate PCN activities beyond traditional clinic or meeting settings. This community-centric approach not only improves healthcare outcomes but also fosters a sense of belonging and inclusivity among patients and their GP practices.
Why Vertical Integration Succeeded in Wolverhampton
The success of primary care vertical integration in Wolverhampton lies in aligned values and cultivated collaborative partnerships. The Trust and GP surgeries share the same goal: serving the community in the best possible way. So far, nine GP surgeries have joined the acute trust through vertical integration.
As a result, they can set ambitious goals for improving population health. This collaborative ethos has transformed the dynamics between primary and secondary care, fostering trust and long-lasting professional relationships essential for effective healthcare delivery.
Evidence-Based Benefits
The vertical integration model has yielded tangible benefits for the practices, including access to relevant operational data such as patient admission rates. A published report showed that vertical integration is associated with modest reductions in A&E attendance rates. Read more here.
Another innovative initiative uses data-driven analytics for prognosticating end-of-life care. The model accurately predicted one-year mortality in hospitalised patients, allowing for anticipatory care and improved outcomes (Ref: Proactive Risk-Based and Data-Driven Assessment of Patients at the End of Life (PRADA)
These examples showcase the significant benefits achievable when primary and secondary care work together seamlessly.
Elevating Your Career and Well-being in Primary Care
In primary care, success isn’t solely measured by medical expertise but also by the strength of connections forged with colleagues, teams, and patients. Dr. Sidhu shared an important insight: making professional connections with colleagues, teams, and patients is crucial to improving your career in primary care.
The team’s strength lies in its ability to communicate openly and candidly. Instead of being confrontational or adversarial, they brainstorm ideas collaboratively, develop joint solutions, and move forward together. As part of the PCN, they have conducted groundbreaking research and received trust support to collaborate effectively with limited resources.
Leveraging Communication and Collaboration
Effective communication is crucial in all aspects of PCN work, particularly in creating a shared vision for all practices in the network. This shared understanding makes collaborative projects much easier to implement.
The PCN employs a communications manager responsible for coordinating both external and internal communication. Information is disseminated through regular structured PCN meetings, educational sessions, and social media platforms. Every quarter, primary, secondary, and community teams convene to discuss challenges and plan forward strategies for PCN patients.
“Leading by example, clear communication, and having a clear vision helped achieve the outcomes of the PCN.” — Dr. Mona Sidhu
In joint meetings, teams explore barriers to progress and gather feedback from frontline staff to improve outcomes. Clear communication, leading by example, and maintaining a clear vision have all contributed to the PCN’s successful outcomes.
Leadership Strategies for Success: The Pareto Principle
One essential leadership principle when managing teams is the Pareto Principle, also known as the 80/20 rule. This principle states that 20 percent of your activities will account for 80 percent of your results.
When faced with competing commitments, the Pareto concept helps identify which communication packages and initiatives to prioritise for the most significant impact across practices within the PCN. Recognising that some are slow adopters of change, the Pareto Principle provides a framework to move forward with early adopters while maintaining continuous communication with other stakeholders and clarifying goals for overall PCN success.
Leadership Advice for Growing Your Career
The leadership style within the PCN may appear hierarchical to staff not directly involved in PCN teams, but it shouldn’t be perceived that way. If you’re doing something innovative and iterating your activities, you’re bound to succeed in your career.
As Medical Director for Black Country, overseeing 27 PCNs comprising 172 practices, Dr. Sidhu’s leadership style is collaborative and distributed. It relies on a group approach to decide strategy and curate diverse opinions toward a shared vision. Care delivery happens at the practice level, where frontline staff know their patients and can shape what works and what doesn’t.
As a healthcare leader, your responsibility is to identify and eliminate barriers, obstacles, or challenges that arise during the pursuit of common goals. Primary care work relies on subjective intuition and acquired knowledge to understand the relationships between different attributes of self and others at every level.
You’re Already a Leader
If you’re working in primary care, you’re already a leader. Get connected with colleagues and the community for a fulfilling career.
I’ve learned a great deal from this interaction, and I hope you have too. If you want to explore ways to get involved in your community as a leader, check out the article on 8 Ways of Promoting Change through Health Advocacy.
