Last reviewed 16 March 2023
A new duty in the Health and Care Act 2022 (HCA) requires health and care organisations to think about the interests of the wider system and creates common system-wide goals that need to be achieved through stronger collaboration between the diverse players within the system. In this feature, Christine Grey looks at what this means for primary care providers and the practical steps they can take in this direction.
The Health and Care Act
The HCA was designed to help make a more joined-up and collaborative system a reality. Legislators say it was formulated against a backdrop of a previous legal framework that allowed NHS organisations to work firstly in the best interest of their own organisations and then, for their own immediate patients. But this failed to properly support the delivery of integrated and truly patient-centred care.
Following the changes in law, NHS England expects organisations to draw on the knowledge and experience of wider partners, including the voluntary, community and social enterprise (VCSE) sectors, local authorities and Healthwatch, as well as their communities, when considering how to meet the new duty. This is not only a contractual responsibility for provider organisations, including general practice, but it also supports NHS England’s wider objectives of integration, which it states are “population health management, personalisation of care and support, addressing health inequalities and improving quality”.
The good news is that, through the Integrated Care Systems (ICSs) established in the HCA, it should become easier to strengthen relationships between health and care providers, and with local communities, voluntary sector partners and local government.
Reasons for working with people and communities
The need for a new model of working comes in the context of an unprecedented increase in levels of demand, restricted resources, a growing prevalence of multi-morbidity and a high number of people with physical and mental health needs that are not easily met by traditional models of care. The Government recognises that a new approach is needed that better supports people to adapt and cope with long-term health conditions (LTCs), which is a population that is predicted to rise to 18 million by 2025, as well as addressing problems associated with loneliness, isolation and old age.
It’s obvious that not all of these issues have a medical solution, and most non-clinical problems can be improved with more support for people to make new connections, to get out, be more active and find help and information from peers tackling the same issues.
The Royal College of GPs (RCGP) agrees that the “the bio-psychosocial elements of health” require a shift towards “prevention, self-care, and integrated care”, and supports the belief that collaborative care and personalised support planning offer a framework to meet these requirements.
Last October, NHS England issued statutory guidance, Working in Partnership with People and Communities, for use by NHS commissioners, provider collaboratives and wider health and care partners to help them meet their duties to engage with the public, support the leadership needed and provide ten principles to follow to build effective and meaningful partnerships within communities.
On a local level a well-tested, data-driven approach, or what is termed “collaborative practice”, is also being used in a practical way in primary care. Using information gathered alongside financial and clinical data, the approach ensures that services are delivered in a way that works best for patients and their carers and can be tailored to the needs of their own community. NHS England suggests that collaborative practice can support general practice to better understand the nature of demand in their area and find new ways of organising that will release resources and create capacity in the system.
Local people on a practice’s list are invited to offer their time and experience to their GP surgery or health service as volunteer Practice Health Champions. They work alongside people who deliver the health services, forming a collaborative relationship to help transform the way the service works. The new, extended practice teams help to tackle “the problems that medicine cannot fix” and develop and lead new offers, groups and activities that meet patients’ non-clinical needs. The Practice Health Champion role “complements and amplifies” the role of social prescribing link workers.
Altogether Better support for practices
Altogether Better, which is an NHS national network organisation that has been facilitating the spread of collaborative practice since 2008, is providing practical support to health services when they choose to adopt the collaborative practice model. This has been tested in over 130 GP services as well as in other health and care settings including care homes, acute hospital trusts, mental health and young people’s services.
Although every piece of work is tailored to the practice and the community it serves, Altogether Better has been providing help in the form of:
development programmes for practice leaders, GPs and practice managers
practical tools, resources and coaching for practices as they bring in Practice Health Champions to work in a team
delivering workshops for staff and the public that form a basis for a collaborative relationship
supporting understanding and use of attendance data to better meet demand
coaching and guidance for practice teams
networks to share learning
support to improve quality of the consultation using an Appointment Guide.
A case study
Altogether Better has published a good example of delivering a collaborative practice leadership and development programme that was commissioned by Public Health Dorset in 2017 as part of a “Prevention at Scale” programme. The aim was to find new ways to respond to the challenge of rising demand and unmet need in general practice in Dorset.
Practices were encouraged to look at how they used data. They were given the knowledge, skills and tools to organise around this information and build the leadership skills to deliver and lead collaborative practice. GPs, practice managers and their teams from 27 practices were supported with a modular development programme that included coaching and mentoring, and in-practice support that involved practical help to find enthusiastic Practice Health Champions, facilitate workshops and help to prototype and develop new offers and interventions.
Twenty two of the 27 practices in the study were able to demonstrate that they had changed their way of working, providing 149 new offers and activities to support patients and practices. The majority reported that their relationships with patients and their communities had changed, with 92% of staff saying there had been a positive shift in the relationship they had with their patients. Only a minority, however, assessed the impact of the work on patient flow.
As primary care services are opened up to local volunteers, it changes who is part of the team, and the identity of the provider. Many GP practices also reported a “fundamental culture shift”, including towards a wellness mindset rather than an illness mindset.
As new possibilities, services, activities and support open up, which are improvements for the provider and important to local people, it starts to feel rewarding for staff and patients alike. And with this approach, pressure is taken off a service by reducing demand for the clinical services, with many GPs reporting a reduction in the frequency of visits in many patients because they are getting the support they need.