Case study – Provider collaboratives: relationships with primary care.

Organisations

The organisations forming the Lincolnshire Health and Care Collaborative are: Lincolnshire Community Health Services NHS Trust, United Lincolnshire Hospitals NHS Trust, Lincolnshire Partnerships NHS Foundation Trust, Lincolnshire Primary Care Network Alliance, Lincolnshire Care Association, Lincolnshire Voluntary Engagement Team (VET) and Lincolnshire County Council. 

Background

Lincolnshire is a relatively small integrated care system (ICS) with a population of approximately 770,000. The Lincolnshire Health and Care Collaborative was formally established in October 2021 as a multi-agency collaborative made up of a range of system partners. Since then, the collaborative has established a delivery board composed of chief executives/executive leads from the collaborative members. The board functions as the provider collaborative leadership board and has agreed terms of reference. A primary focus of Lincolnshire Health Care Collaborative will be to deliver service redesign and transformation and improve system sustainability.

Within the collaborative sits the Lincolnshire Primary Care Network Alliance (PCNA) which was developed in 2019 to provide a unified voice for general practice in order to influence new pathways, service delivery and workforce development at a system level.

Ways of working

• When the PCNA was established in 2019, the chair of the group asked to meet with the chief executives of the three NHS providers in Lincolnshire with a single ambition of integrating services to improve patient outcomes. There was a collective realisation that individually, each organisation would struggle to make a real difference. However, by working together they could.
• At an early stage the PCNA carried out some organisational development work with the local medical committee (LMC) and is in the process of setting up a primary care advisory group. This group will include the PCNA, the LMC, former clinical commissioning group (CCG) clinical leads and representatives from optometry, dentistry and pharmacy. This advisory group will be the unified voice that engages with the Lincolnshire ICB and provider collaborative to take up issues that are affecting general practice and primary care.
• The ICB has delegated the leadership of three programmes of work to the collaborative: ‘care close to home’, prescribing and musculoskeletal services.
• LHCC manages its key governance and assurance relationships via a ‘double lock’ mechanism. This involves the collaborative providing a monthly assurance report to the boards of member organisations; and LHCC runs a regularly pattern of performance and delivery meetings with the ICB to manage progress and agree any adaptations to plans.

Realising the benefits

Changes to the musculoskeletal services across Lincolnshire are a good example of how providers have collaborated to achieve service transformation, with positive outcomes for patients.

The collaborative has worked to support PCNs to embed virtual clinics for hip and knee surgery into their working practices, transforming the musculoskeletal pathway. This means that patients are able to see a first contact physiotherapist and a consultant in one virtual room, making decisions about what happens to their ongoing care. Securing clinical leadership for these changes has catalysed further engagement with general practice because of clear benefits for patients and reduced workload for GPs.

This musculoskeletal (MSK) initiative has also reduced the length of stay to some of the best results in the country. By using a prehab clinic as part of the MSK pathway, they’ve also seen people voluntarily coming off the surgery waiting list because their prehab care has been so good. This has allowed providers to focus on long waiters and provide care for those who require it most.

Key enablers

The collaborative members feel that the key enablers of success in their relationship with primary care are:

• Engagement of primary care stakeholders at the outset of the journey towards provider collaboration, rather than once the strategic conversations have started.
• Primary care having a seat at a strategic level as an equal partner. In Lincolnshire this was helped by the fact that they had the PCNA providing a single voice for all PCNs in the footprint.
• The clinical directors within the PCNA are clear that their core purpose for working as part of a provider collaborative is population health management and ensuring the resilience of general practice itself. This supports building resilience through service redesign which supports recruitment into general practice in Lincolnshire.
• Making sure the clinical directors are aligned and that the LMC feels part of the journey because they represent individual practices.

Key challenges

• Implementing vertical integration can be difficult both culturally and politically. Getting organisations to share with a sense of openness takes time.
• Developing and delivering strong plans, metrics and trajectories is challenging but important.
• Organisations pooling of sovereignty for the greater good is difficult, but seeing the benefits of greater collaboration has helped organisations to navigate the inevitable tensions and challenges.

Next steps

• Looking ahead, the PCNA is going to be doing some work on frailty which involves asking three PCNs to model a new approach. This will focus on investing resources in proactive case management to alleviate pressure on patient flow at emergency departments.

Provider Collaboratives webinar – 22 September 2022

This event explored:

• the relationships provider collaboratives at scale are developing with partners in primary care
• the creative solutions members are finding to navigate complexity
• what needs to be in place for these new relationships to flourish
• examples of the benefits providers are experiencing from having nurtured these new relationships with primary care.

Find the presentation slides here.

Chair:
Jenny Reindorp, Interim director of programme, NHS Providers

Providers Panellists:
Silas Nicholls, Chief executive, Wrightington Wigan & Leigh NHS Foundation Trust

Dr Sunil Hindocha, Co-chair, Lincolnshire Health Care Collaborative – from 24:05 in the above webinar recording.

Peter Noble, Managing director, Lincolnshire Health Care Collaborative