We kick off this new series with Stockport Together and Dr Cath Briggs. Dr Briggs is a General Practitioner in Stockport’s Bracondale Medical Centre. She also holds the role of Clinical Director for Quality and Provider Management at the CCG, and has been actively involved in the Stockport Together transformation work from a clinical perspective, and has been working on the programme since it began. We asked her some questions about what it was like being involved in a Vanguard service development and this is what she said:
What does being a vanguard mean to you?Being a Vanguard provides us with the real opportunity to do something different in Stockport in order to transform the way care is delivered in the borough. It gives us the chance to work with patients and put them at the heart of our plans, rather than contracting and commissioning arrangements that may have previously driven some decisions around care.
What problem did you want to solve?
We’re really keen to put the person back at the centre rather than process or organisational form. We want to ensure that pathways and decisions about peoples’ care are focused on the outcomes for the individual.
How did you go about it?
It’s still work in progress, but the main thing that has helped us get this far is by getting people to work together – whether that’s the partner organisations at a leader-level, through to different professionals and specialities on the front-line. Working together is key to identifying the blocks that exist in the current system, and being able to come up with solutions that will help to solve them across social care, the acute setting and primary care. Allowing the changes and plans to be clinically-led helps to identify both what is necessary as well as what is feasible, all for the good of the people of Stockport.
In practical terms what difference have you noticed and has the way you work on a day-to-day basis changed at all?
The main difference that I have seen is how all of the partner organisations are more visible to each other, which has resulted in much greater team working. The main focus of discussion amongst each of the professions when talking about planning service changes or making care plans for patients is on outcomes rather than being driven by which organisation will deliver individual elements of care. There is now a lot more collaborative working across the organisations, indeed rather than coming and working at the CCG offices, it now feels very much like working at Stockport Together. This is helped but the introduction of the ‘collaboration hub’ and working set-up that means staff from any of the partner organisations can access.
What has the reaction and what has the level of staff engagement been like?
At a high level, we’ve had really good engagement – all of the leaders from the partner organisations are fully signed up to what we’re aiming to do under Stockport Together. We need to focus now on engaging people on the front-line. This has been a slower process, but progress is being made. The Stockport Together team recognises the importance of getting staff groups onboard, as well as getting them involved and keeping them up to date with the plans and progress. Different staff groups have had more engagement with others, and it has been driven by the plans. For example, consultants, GPs, nurses and social workers have all been part of the design and implementation process to date, but there is a lot more still to do.
How would you explain the way your new care model works to members of the local community?
In its simplest form, we are designing care at a local level. This means that over time, the people of Stockport will be able to access care locally through teams working differently across health and social care. We’re aiming for many more health and care services to be accessible within the neighbourhoods across our borough, rather than being delivered centrally, for example in a hospital setting. We want members of the public to be aware that our health and care system is primary-care led.
What is already having or what is going to have the greatest impact and value for patients as a result?
In the first instance, we are focusing on the over 65s and vulnerable people, including those who are prone to falls, or frequent A&E attenders. We have established a series of neighbourhood-based multi-disciplinary teams (MDTs) comprising GPs, social workers and district nurses, who are already looking at this cohort of people. This group is meeting regularly to identify and discuss people who fall into this category, to ensure that the care is being arranged and delivered in an integrated way. The ultimate goal is to provide better care for people in their home setting.
Do you have any great case studies that immediately spring to mind or can you tell me what your most satisfying day at work has been since becoming a vanguard?
http://www.stockport-together.co.uk/latest-news/doctors-connect-speed-care
What do you think has been the most difficult challenge or barrier to overcome?
The area where we still have a lot of work to do is engaging with front line staff. We’ve made real progress since amongst the leaders and higher level staff Stockport Together formally started in January 2015, but getting messages down to those working on the front line is tough. We’re working on our engagement plans in order to get them to be part of the change – we are introducing systems such as Crowdsourcing to all us to do this much more effectively.
Vanguards are leading on developing new care models that will act as blueprints for the future of the health and care system in England. What advice would you give to anyone looking to adopt your new care model?
For me, the main piece of advice would be to say that engagement is key. From staff at all levels from each of the partner organisations, through to voluntary organisations and the public, if you want to get people to understand what you’re trying to achieve – and crucially, why – you need to get everyone involved as soon as you can.
How are you sharing learning?
In Stockport, we’re doing a lot to share our experiences and bring people along with us. We’re holding sessions for front-line staff in each of the neighbourhoods across the borough to encourage the different professions to work through the problems and help us reach a solution – this is how our neighbourhood teams have been formed. We’ve also held events which are specifically for GPs and hospital consultants. These have been hosted in answer to feedback that the two professions don’t know the other well enough, and need to foster stronger relationships in order to address issues around referrals. In order to share learning amongst other Vanguard sites, representatives from Stockport have attended and presented at a number of health and care events and conferences across the country and have attended and hosted a number of different Vanguard sites to have in-depth discussions about individual plans. Stockport is also part of the NHS England Rapid Testing programme. We were selected as one of two areas to design and implement a number of rapid improvement programmes, and were the first site to go live as we launched last week (8th and 9th June 2016). In addition to this, a series of public engagement sessions have been held at community and health and care interest groups throughout Stockport.
What do you think your vanguard and the service it delivers will look like in 12 months’ time?
In 12 months’ time, we will be at a stage where many of the plans we’re designing or in the early stage of implementing at the moment will be up and running. In 12 months our MCP will be fully operational, we will have all neighbourhoods operating fully, with a true mix of health and care professionals, as well as voluntary sector and mental health support included. And we will have moved to an outcomes-based contracting model. In short, many of the plans we’re working on now will have been put into place, and the public will be seeing a more integrated health and care service that is better meeting their needs in a more appropriate location.
From your work so far, what's your one top tip (or learning) that you could share right now with us, that we could learn from and implement within our work areas?
In order for any of the changes to happen within health and social care, the crucial area to focus on would be contracting. If you want to get buy-in from staff across each of the different partners, they have to see that you’re doing something different. For us it has been moving away from standard activity-based contracting into capitation or block contracting in order to encourage people to make the changes that need to happen if we’re to make a real difference with the transformation plans.
Thank you Dr Briggs and Stockport Together for sharing your experiences, The Blonde has learnt a lot.