Primary Care Is Changing

16 August 2016

Taurus Healthcare, the GP Federation for Herefordshire, continues to drive change in service delivery both as a provider in its own right and through internal transformation of primary care.

We are known for our seven-day full primary care service with integrated, compliant data sharing (via the GP Access Fund) that changes the ethos to a single service both in hours and in extended hours. This reduces the need for patients to revisit their own surgery and enables intervention, routine and urgent referrals if indicated. This minimally disruptive medicine is fully aligned with our founding values of doing things better to create efficiency, rather than just reducing the service offer to make savings. The resultant service is very much valued by patients and colleagues.

We also provide an integrated sexual health service in partnership with community colleagues, a service for violent and aggressive patients and a new service delivered by ‘Integrated Care Practitioners’ that manages the high-risk area between inpatient discharge and return to thriving in the community. This exciting service is delivered around the registered patient list and as well as having great patient feedback is reducing hospital readmissions, using validated data. This service is crucial, as returning patients to their home environment in a safe but efficient manner is absolutely essential in keeping more people where they want to be, at home.

It will not have escaped the attention of those within the NHS that we are having a massive strategic planning process via the Sustainability and Transformation Planning (STP) mechanism. This provides a new opportunity for primary care at scale to have an area wide strategic voice, if we engage with the process. All too often in the past, wider primary care has only had a commissioning voice in this discussion and has felt conflicted with voicing our provider strengths. Speaking with a single strategic voice (via an agreed democratic process) primary care can influence and deliver transfer of care, workforce development, that is critical for our survival, and have discussions with other providers and commissioners as an equal at the table.

Herefordshire Local Medical Committee has given Taurus the mandate to take on this role and regularly feedback.

In Herefordshire, we have signed, with our commissioner and provider colleagues a shadow alliance Memorandum of Understanding that enables to come together and make strategic service decisions on a ‘Best for Herefordshire’ basis rather than best for any single organisation. This is a big step forward to developing shared ownership and risk and makes absolute common sense if we are to start making large systemic changes.

Very few single practices have the capability to develop the skills and personnel required to deliver the new ways of working discussed in the GP Forward View. By operating at scale we can share the risk and develop skills and training through our Community Education Provider Network (CEPN), delivered in Herefordshire by Taurus. We have also been very fortunate to be taking the lead role in workforce planning in our STP.

In a recent development we have been asked to take a role in our regional Urgent care network – again extending the voice of communities based around the registered list, to a much larger area.

Taurus has spent a great deal of time cementing the democratic processes vital in a growing organisation. Our board now has a wider primary care representation with each of our four localities having a locality director on our main board. Our locality directors feedback, hold locality meetings and influence main board policy, enabling individuals and practices to feel their voice is heard. Our practices have given us the mandate to explore new contractual options to secure stability and resilience. We are investing heavily in getting this right and are using our reserves to fund a project team to deliver this over the next nine months.

In summary, the next months and years offer huge opportunity for true reform and we at Taurus are determined to be playing our role via strategic partnerships and alliances and by delivering innovative quality services. We understand that the cavalry are not coming but we also understand that we have the tools and the conviction to make a difference.

Nigel Fraser is Chairman of Taurus Healthcare and a Partner at Wargrave House Surgery in Hereford City centre.

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