The development of integrated care systems signals a move to a different way of working between organisations in the NHS and local authorities.
One of the best examples in the world of an integrated system is found in Canterbury, New Zealand. South Tyneside has been fortunate enough to benefit from a unique strategic partnership with colleagues in the Canterbury District Health Board for the past four years.
What attracted us to the Canterbury approach was their move away from traditional commissioner/provider behaviours and organisation-centredness to a collaborative way of working which was truly whole system, and based on a ‘best for patient, best for system’ approach.
Canterbury’s progress and sustained outcomes are a powerful illustration of what can be achieved when all parts of a system come together with a common purpose and vision to improve the health of the population they serve.
Learning into action
We were so taken with this approach that our partnership quickly moved to adopt Canterbury’s philosophy. We developed our own ‘alliancing approach’ to system working – a collaborative way of planning and decision-making across commissioners and providers – which we set out in our alliance charter.
While we would always want to use our South Tyneside pound wisely, we found we had to learn to say “yes”. To support this, we brought together the key opinion leaders from across our organisations to simply talk about the behaviour change we were going to have to live out. The Alliance Leadership Team really struggled with letting go of control and not acting like a ‘normal’ management meeting.
One of our biggest challenges was the development of trust between people in the system. We knew we wanted to develop a ‘high trust, low bureaucracy’ approach, but had to work hard to reproduce this. An example was our local GP incentive scheme, traditionally used to incentivise our GPs to take on tasks not covered by their normal contracts. In 2016, our existing scheme had become a very unwieldy set of spreadsheets, detailing small components of work each with a tiny amount of money attached to it.
We radically redesigned our Better Outcomes Scheme to demonstrate that we actually trusted our practices to do good work if we gave them money. Essentially, we gave practices collectively £750,000 and asked them to look at their practice data, do some improvement work and produce a poster to share their learning. The results were remarkable.
All practices actively engaged, some doing very simple but effective pieces of work aimed at improving patient care. The event where the posters were shared was one of the best GP education events we have hosted. The feedback from practices was incredibly positive.
To support our GPs and with the help of our commissioning support unit, NECS, we also implemented a system called HealthPathways.
This is an online repository of condition-specific pathways of care which are accessed by GPs within their clinical consultations. The aim of the site is to provide standardised pathways to aid decision-making. The process for developing each pathway involves a discussion between a clinical editor from primary care and a subject matter expert, usually a secondary care consultant.
Despite a primary target audience of GPs in clinical practice, the site is made available to all health and social care staff in South Tyneside. Since its launch, the use of the site has grown exponentially.
This initiative has further helped with the principle of working at the interface between primary and secondary care, helping support the relationship across the system. Through its introduction, we have an increasingly blurred boundary across acute and community.
Our focus on clinical engagement is also really shifting. This year, we have run a series of clinical workshops across primary and secondary care with neighbouring clinical commissioning groups. The focus has been on getting front-line staff to describe what they think needs to change in their work. The ideas generated have formed the basis of our system transformation plan and our system financial recovery plan for the next three to five years.
This represents a transformational change and therefore despite significant progress to date, it is still at an early stage. We are, however, starting to see results.
This ethos and way of working is also spreading. We think there is now a sea change with like-minded systems similarly recognising that care is a team game, and that the shared goal is to work as part of a system which focuses on supporting residents to stay well in their own homes. We would be interested to know if other people feel it too.