– 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 are responsible for managing a wide range of health issues and coordinating care with specialists and other key services for the community. Despite its crucial function, primary care often operates under the radar, lacking the recognition and investment it deserves. However, since 2019, initiatives like Primary Care Networks (PCNs) have emerged as solutions 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, the Primary Care Medical Director for Black Country ICB, and Dr Bukola Olomolaiye, a GP at Coalway Road Surgery and the Deputy Clinical Director at the Royal Wolverhampton NHS Trust Primary Care Network. We’ll explore the organisational dynamics of their PCN, cultural ethos, and leadership style for transformative potential in a primary care career.
The Structural Framework of Primary Care Network in Royal Wolverhampton NHS Trust:
Dr Olomolaiye shared his insight into this structure. Primary care is delivered mainly through the GMS contract between the NHS Commissioning Board and GP Practice Partners. In the vertical integration model, this unique contractual responsibility is delegated from the GMS contract holders to the acute trust. The acute trust is then responsible for employing GMS contract holders as well as other primary care staff, delivering the 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 (Primary Care Network) operates within the primary care division of the Royal Wolverhampton NHS Trust. It works in collaboration with community teams, public health sectors, voluntary organisations, and patient groups to create stronger connections across the healthcare landscape. This approach is aimed at providing holistic patient care under the Network Contract DES.
Empowering Community Engagement and Healthcare Accessibility:
Central to the mission of the PCN is the empowerment of 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 the doorstep of residents. The deployment of community teams facilitates home visits and proactive health promotion activities, using social media, offering communication about the PCN activities beyond the 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 is the vertical integration successful? :
The success of primary care vertical integration in Wolverhampton lies in the alignment of values and the cultivation of collaborative partnerships. The Trust and the GP surgeries have the same goal of serving the community in the best possible way. So far, nine (9) GP surgeries have joined the acute trust by vertical integration. As a result, they can set ambitious goals for improving the health of the population. This collaborative ethos has transformed the dynamics between primary and secondary care, fostering trust and long-lasting professional relationships essential for effective healthcare delivery.
Some benefits of the vertical integration model for the practices have been the availability of relevant operational data like the admission rate of practice patients. They published a report that showed that vertical integration is associated with modest reductions in rates of A&E attendance. Read more here.
Another innovative work is the use of data-driven analytics for prognosticating end-of-life. The model accurately predicted one-year mortality in hospitalised patients. This allows for anticipatory care and improved outcomes. (Ref: Proactive Risk-Based and Data-Driven Assessment of Patients at the End of Life (PRADA)
These two examples showcase how much benefit can be achieved when primary and secondary care are working together.
How to Elevate 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 into improving one’s career in primary care. It is crucial to make professional connections with colleagues, teams, and patients. The strength of the team lies in the ability to communicate openly and candidly with each other. Instead of being confrontational or challenging, rather brainstorm ideas relationally, come up with joint solutions and move forward. As part of the PCN, they have conducted groundbreaking research and received support from the trust to collaborate for limited resources.
How to use Communication and Collaboration to your advantage:
Effective communication is crucial in all aspects of the PCN work, and it is especially important to use it to create a shared vision for all the practices in the PCN. This way, working together on projects becomes much easier. The PCN has a communications manager who is responsible for coordinating both external and internal communication. Information is disseminated through regular structural PCN meetings, educational meetings, and the use of social media and other non-print media. Every quarter, primary, secondary, and community teams come together to discuss the challenges and plan a way forward for the patients in the PCN. Clear communication, leading by example, and having a clear vision have all contributed to the successful outcomes of the PCN. In the joint meetings, explore the barriers to progress and take feedback from frontline staff to improve outcomes.
Leading by example, clear communication and having a clear vision, helped achieve the outcomes of the PCN.
– Dr Mona Sidhu
Leadership Strategies for Success:
One of the essential leadership principles when managing teams is the Pareto Principle, also known as the 80/20 rule. This rule states that 20 percent of your activities will account for 80 percent of your results. When faced with variable commitments, the Pareto concept helps identify which communication packages and initiatives to prioritise to achieve the most significant impact from the practices in the Primary Care Network (PCN). There are slow adaptors to change, and having the Pareto Principle gives you a framework to forge ahead. It allows for continuous communication and clarification of goals for the overall success of the PCN activities.
Leadership advice from a GP professional to grow your career:
In terms of leadership style in the PCN, it may seem hierarchical to most staff who are not involved in the PCN teams, but it really shouldn’t be. If you are doing something innovative and iterating your activities, you are bound to succeed in your career. However, as the Medical Director for Black Country, overseeing 27 PCNs made up of 172 practices, the leadership style is collaborative and distributed. It relies on a group approach to decide on strategy and curate the diversity of opinions towards a shared vision. Bear in mind that care delivery is at the practice level, and the frontline staff know their patients and can shape what works and what doesn’t.
As a leader in the healthcare industry, it is your responsibility to identify and eliminate any barriers, obstacles, or challenges that may arise during the pursuit of common goals. Primary care work and activities rely on subjective intuition and acquired knowledge to understand the relationships between different attributes of self and others, at every level. This makes primary care professionals very unique. These leadership skills are transferable between different scenarios and can be leveraged by leaders to think and act confidently in various situations to achieve a shared outcome.
If you are working in primary care, you are already a leader. Get connected with colleagues and the community for a fulfilling career.
I have learnt a lot from this interaction, and I hope you do 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.
