Setting up a ‘super partnership’ – how did the first year go?

Some of my reflections a year on from forming Our Health Partnership (OHP). An exciting and challenging period with many lessons learnt. Let me know if these ring true in your organisations in the comments below.

Working towards optimal scale

Establishing a new organisation is incredibly exciting, however it is also certainly costly, and it takes time. After the initial enthusiasm, there is an eagerness to get established and start to realise the hoped-for benefits. But starting from scratch means that there is no infrastructure and fewer people to actually do things! Foot soldiers are scant, and even in the medium term it won’t be possible to appoint lots of them. Therefore, all appointees and at all levels will have to be prepared to act down and get their hands dirty at times. Quite a change for those who, like me, have previously worked in an acute Trust, but also an excellent challenge.

At 280,000 patients, we are a large organisation (our list size is comparable to the population served by many hospitals). And yet, our experience is that we could benefit from being even larger. In the absence of outside funding, when all resources come from member partners it is crucial to keep the running cost as low as possible. Creating a central facility that is sizeable, and experienced enough, to generate substantial benefits for partners is costly. To reach best returns we need to ensure that it serves as many partners/practices as possible. Our feeling is that somewhere around 350-400k patients is probably about right for us.

Enabling GPs

OHP has started getting noticed now. I have to admit to thinking that partners would perceive the wider recognition and influencing to be less important than achieving direct benefits of scale for practices. But this is not so, perhaps because GPs are feeling pressured and vulnerable, and powerless to influence the coming changes that will impact on their future work.

OHP has been able to ensure GPs are directly involved in the STP (Sustainability and Transformation Plan) process in Birmingham and Solihull, and partners feel this is both desirable and important. We did this by working in partnership with several other large GP providers, bringing majority population coverage and greater impact at system level.

Of course, the ‘key resource’ we have is our people. We are thinking a lot nowadays about our culture and ethos.

What does it mean to be a partner in a large partnership where you cannot know all your colleagues personally? Recently, one of our practices suffered an acute staffing shortage, and it was heartening to see medical and managerial colleagues pitching in to support.

This has opened a wider debate about our ‘informal’ obligations, and about what we wish to become as an organisation. The possibilities are endless, and exciting!

We think that is is important to be ‘flag wavers for ‘partner-based general practice’. Locally autonomous independent practice is one of our founding principles. But I hear many voices that say an employed model is the future, often followed by a statement that GMS practice is outdated and no longer viable. We disagree.

We feel that practices run by locally responsive partners will bring the highest levels of quality, because accountability and decision-making capability are embedded right where they should be, at the patient interface.

In OHP we are confident that, come the day when practice quality is measured more consistently and rigorously, the value of our approach will be clear. Time will tell, but we feel reports of the demise of partner-based general practice are premature.

Looking to the future

After almost a year we now feel a strong sense of ‘momentum’. Very soon our twin pillars of fully merged accounts, and single CQC registration, will be achieved. These are major milestones that cannot come soon enough.

Finally, I believe that all good organisations have high levels of staff engagement and this principle is very high on the agenda at OHP. After all, engaging with staff is no soft measure and as we know (in hospitals at least) it correlates with the quality of service provided to patients.

Unfortunately, in my experience boards have a tendency to become distant and less approachable over time. As a brand new board, we have made it our business to prevent this from happening. Each board member now represents a locality and will dedicate time to meeting colleagues and providing a link between our practices and the OHP Board. Communication matters a lot, and face to face contact is a crucial part of this – watch this space to see if it works!

I hope you are finding the articles on GP View of interest? We are very keen to start a debate, so please do contribute your views – we would love to receive your comments on our blogs, or on Twitter, or indeed a blog of your own. All points of view are welcome, as long as they stimulate debate!

Author – Dr Mark Newbold  (Editor at GP View)  mark-newbold


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