Delivering partnership working in West Cheshire – The Rural Alliance, North West

The Rural Alliance is a group of six practices in rural West Cheshire who have come together to work collaboratively.  The alliance is made up of 18.2 whole time equivalent GPs serving a patient population of approximately 38,000.  It participated in the Learning in Action programme to develop closer and collaborative working to help achieve efficiencies in systems and processes across the locality. The programme is delivered by NHS England and part of the support available through the General Practice Forward View.

Note: Some sections of this case study refer to clinical commissioning groups (CCGS). On 1st July 2022, integrated care systems (ICSs) took over statutory commissioning responsibilities in England, and CCGs were closed down.

The idea

Work collaboratively to tackle common issues and make better use of staff and resources, helping to deliver a better and more consistent patient experience.

Building on a collaborative foundation of working

All practices in the alliance committed to a series of workshops held over six months, each practice was represented by a GP, practice manager and member of admin staff.

The group identified the projects it wanted to focus on across the alliance, these included improving discharges of frail and elderly patients, looking at developing more efficient systems and processes across the alliance, and active signposting. Different working groups were formed and individual practices took the lead in driving the projects forward with the support of other practices in the group.

The groups discussed what the issues were in individual practices and how they could be tackled across the alliance. During the discussions teams shared what was already working well in their practice and could be rolled out across the alliance. For example, some practices were more advanced in active signposting, while for others the repeat prescriptions process was working successfully.

Recognising how easily some changes could be achieved motivated the groups. As a result they became more open and willing to share their ideas and work together.

Working as an alliance to collaboratively make changes

The groups worked together over the following workshops to further explore some of the issues and set about making changes.

  • A clinical working group has been formed that looks at improving discharges of frail and elderly patients from hospital. With the aid of a Community Care Co-ordinator and closer contact with the local hospital, it ensures that where patients can be returned to their homes, care packages are put in place.
  • Cross-organisation booking and communication links have improved across the alliance, making better use of diabetes clinics.
  • Some practices recognised they had an IT skill gap in their team. Rather than individually recruit they collaboratively recruited a fulltime IT post that is shared amongst their practices.
  • To help practice managers work closer and explore opportunities to work more effectively across the alliance, a Whatspp group has been set up which has improved communication amongst this group.
  • Working with the CCG, the Rural Alliance Practices Active Signposting training, has been delivered to all practices, ensuring consistency of approach to signposting and making staff more aware what services are offered by other practices in the alliance.

Developing quality improvement skills across the alliance

Prior to the programme practices in the alliance had limited exposure to quality improvement. Working through their projects they were able to learn about different change tools and techniques such as the Change Model and PDSA (Plan, Do, Study, Act) cycles; tools that equipped teams with the skills to continue making changes into the future.

There was great power in groups collaboratively learning about the tools and approaches together.  During one session a group ran a process mapping session for repeat prescriptions, highlighting they were all doing the same process differently.  This encouraged them to be more open to suggestions from others on how they could change.


  • The alliance has made further progress in working together and is ideally placed for its patients to benefit from the Primary Care Networks being developed.
  • Relationships have developed and strengthened across the alliance enabling for better and closer working across practices e.g. there is now more sharing of GP specialities and practice managers share attendance at CCG meetings.
  • Patients are benefiting from no longer having to travel into the city for specific clinics and services e.g. dressings, diabetes and sexual health. As these are now available within their rural locality patients are spending less time and expense on travelling.
  • Practice managers have achieved success in collaborating on CQUIN reporting and moving some supplier contracts to a collaborative deal on more favourable terms.
  • Consistent processes have developed across the alliance e.g. cross organisational booking system for diabetes clinics, all practices now managing their clinical documentation through Docman.
  • Practices across the alliance are making better use of shared resources e.g. IT support.

In working together we have all found ways to become more efficient and improve patient care. It has made our CQUIN reporting easier and we are very well prepared to form a Primary Care Network to further support our rural patients. We are no longer re-inventing everything six times. Kate Evans, Practice Manager, The Village Surgeries Group