We are working with Practices and PCNs in a number of areas as they respond to proposals for General Practice Provider Collaboratives (GPCCs). It is clear that the NHS is looking for national coverage of collaboratives and that there are plans for these to play a key role in the strategy for Primary Care (Fuller Stocktake etc).
Our worry is that the ‘system’ may look to force the creation of GPPCs that seem logical in the way that the NHS is organised, rather than focussing on encouraging practices to collaborate in ways that benefit them and reflect patient pathways and traditional ways of working.
In considering the footprints for new GPPCs it may be worth considering:
- PCNs have worked best where there is a genuine desire by the practices to work together, rather than simply putting together a structure to deliver the PCN DES.
- PCNs are very different, ranging from populations of circa 30,000 to 130,000 and in many places without a logical neighbourhood footprint.
- Most PCNs are much too small to be the footprint useful for Fuller initiatives.
- Place footprints (the way most Integrated Care Boards (ICBs) are organised) are mainly based on Local Authority footprints. These often don’t have any logic in respect of General Practice and on patient flows.
- Place footprints are in the main too large for the footprint to be useful for Fuller initiatives.
- Local Authority (LA) footprints are changing – there are going to be huge changes over the next two years in areas either covered by two-tier LAs or where new devolution proposals are in place.
- ICB footprints are very different (with populations ranging from 500,000 to 3 million) and in the main are based on historic structures and ways of working.
- Many Secondary Care Provider Collaboratives don’t follow the NHS models – particularly where Trusts work together in provider groups.
- The most successful General Practice collaborative initiatives have been driven through GP Federations, with these Federations being formed and run by GPs who want to work together, usually covering populations of between 100,000 and 300,000.
We are in danger of failing to learn lessons and to ‘conscript’ our practices into a model that doesn’t make sense to them and that are not based on a ‘coalition of the willing’. Interestingly we seem to have been comfortable for our ICB and PCN models to be illogical, but we are looking to create a standard operating model for GPPCs.
Our suggestion is that the new collaboratives should be built on the current successful Federations or groups of PCNs that currently collaborate, and reflect the ways that practices want to work together!
