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With integration between primary and community care so high on the national agenda, it is a smart PCN that wants to build a productive relationship with its local community provider now. Despite the uncertainty as to what actually constitutes an integrated neighbourhood team, the likelihood of the imposition of joint working arrangements looms ever larger. Getting ahead of the game now will give general practice a much greater opportunity to influence and shape the future.
But how do you go about it? In many places establishing effective joint working has proven challenging. Community teams can seem more distant from practices than ever before, and disputes between community nursing teams and practices over things like home visits have been ongoing for many years. Here are five top tips based on my own experiences and talking to top community leaders such as Matthew Winn.
1. Start with a joined-up approach across PCNs
While we ultimately want to develop relationships within the clinical teams working within the PCN area, it is extremely helpful if the PCNs can agree a joint approach to working with the local community provider. While each PCN will undoubtedly have its own ideas as to what to focus on and where to start, if a coherent approach can be agreed across the PCNs (such as what we will do together, what we will do on our own and what success would look like and so on) then the chances of engaging the local community provider at the outset will be much higher, as they will feel like they are participating in one piece of work rather than six or seven separate ones.
As an aside, given where we are right now if you can frame this work in some way as flavour of the month ‘integrated neighbourhood teams’, and involve the local integrated care board (ICB) in the conversation, then the chances of getting system support and even resources will be much higher (see no. 5).
2. Obtain the support of a senior leader within the community provider for this work
People in senior positions do not make change happen. However, they can be an enabler for change, and they can also block change from happening. Often when we start a conversation with our local community teams at the first sign of trouble we end up back at square one. Other times local teams can simply back off, called away by their organisation because of ‘other priorities’. But senior leadership support can reinforce the importance of the work, provide an escalation point when progress stalls, and ensure the ongoing commitment the work needs to be successful.
Who do you go to in the community provider for this? The key here is finding the right senior person, rather than any specific role or title. There tend to be senior leaders within NHS organisations more supportive of collaborative working than others (the same is probably true within general practice!) and these are the leaders to engage. Asking ICB colleagues and those with experience of working across the system who they are is the best way to find them.
3. Start with existing initiatives
Where do you start with this work at a PCN level? A common mistake is to start with the complaints and gripes that each side has. Practices will share all the shortcomings of the community teams, who then in turn outline their frustrations with practices. Before you know it everyone’s hackles are up and relationships are worse than when you started. Instead, a top tip from National Director of Community Health Matthew Winn is to start with the existing initiatives that the PCN and community team already have underway, and to share and review data together on how these are working or being utilised. Joint work on how to make the most of these initiatives can be a great way of delivering some early wins.
4. Focus on relationships
Over the last four years most PCNs have understood that building trust and strengthening relationships between practices in the PCN is the key to successful PCN working. The same is true for joint working between the PCN and community teams.
Many of the issues between primary and community care stem from the almost adversarial relationships that have developed. Referrals feel like passing off work to someone else, rather than asking that person or team for help. But where areas have established a common mission on making improvements in a shared area or for specific population groups, and have built trust across the wider team, then individuals can start to feel like they are working together rather than against each other.
Ultimately developing these relationships means the community and PCN teams spending time together, getting to know each other, and identifying and agreeing new ways of working. There is no real shortcut, and it can only be accelerated by undertaking joint organisational development sessions such as strategy sessions and away days.
5. Identify resources
Investing in relationships takes time and energy, and cannot be an activity that is just be added on to the to-do list or else it will constantly be replaced by urgent transactional activities. It requires funding for project management support, clinical leadership time, and joint strategy and development sessions. Push your local ICB to fund this work, because its success will be high up on their priority list.
Ben Gowland is director and principal consultant at Ockham Healthcare, a think tank and consultancy. He was an NHS chief executive for eight years and has also been a director of Croydon Health Services NHS Trust. He established Nene Commissioning, first as a PBC organisation and then as one of the largest CCGs