When the new models of care were first introduced in the Five Year Forward View, there was concern in some quarters of General Practice that the PACS model (Primary and Acute Care Systems) could herald the takeover of General Practice by local hospitals. Ben observes that this is far from what is actually happening…

When I read of the Symphony Programme in Yeovil, one of the PACS vanguards, it looked like this indeed was what was happening. A number of local practices – initially 3, then 6, and potentially 10 – were reportedly joining a company, Symphony Healthcare Services, which is wholly owned by Yeovil hospital.

I contacted Dr Berge Balian, a GP and the Chair of the South Somerset Symphony Programme Board, to find out whether the rumours were true, and if so why the local GP practices were allowing this to happen. We spoke, and what I discovered was surprising. He kindly agreed that we could use the conversation as a podcast, which you can find here.

The first surprising point is the focus on General Practice, and developing it to play a leading, sustainable role in the delivery of care, through an enhanced primary care model. This includes incorporating health coaches within practices, as well as extending the care team to include mental health, pharmacy, and therapists.

The second is the starting point for working together: both General Practice and the acute hospital are experiencing the same pressures, of demand, recruitment, and finances. There was a realisation in conversations between the two that by combining they could more effectively meet these problems. As Berge puts it, ‘The ultimate outcome is that the hospital is going to shrink’, as it focuses on doing only what it absolutely needs to do. Working together provides the mechanism for moving resources, whether money or personnel, from secondary to primary care, in ways that could alleviate pressure on both sides.

Berge was an LMC chair. He knows General Practice inside out, and has its best interests at heart. Inspired by the vision of the Chief Executive at Yeovil Hospital he took on a role there as Associate Medical Director for Primary Care. Together with the Chief Executive they began building bridges between the hospital and the local practices. Berge knew change in General Practice starts by building trust, and he recounts 18 months of conversations that they had with all of the local practices, strengthening relationships and ironing out problems. A key part of the battle, Berge recounted, was convincing the practices this was not a clandestine way to negatively impact General Practice.

What happened next was most interesting. A number of local practices became so overwhelmed with their own problems they approached the hospital directly wanting to formally merge with them. The hospital considered this, but Berge wanted to ensure the valuable G/PMS contracts, which are contracts in perpetuity, were protected. As a result, they set up a complicated set of arrangements (under the banner of Symphony Healthcare Services) that means the existing contract is preserved, the organisation is at arms-length from the hospital, it is led by primary care clinicians, and the lead partners have a ‘right to return’ to their original contracts in future.

Impressed by the hospital’s commitment to making this work for General Practice, another 6 or 7 practices have expressed an interest in fully integrating with the hospital through Symphony Healthcare Services. And not just the ones in trouble. As Berge says,

“About half are motivated by some challenges they are having, but another half really just see the future of General Practice being in a different model to the historical smaller partnership model.”

The integration of the practices with the hospital is built on what are described as “three pillars”: to preserve the individual identity of each practice; to share administrative and back office functions across the practices and the hospital; and to redesign the healthcare system, through the enhanced primary care model and shifting how care is provided for patients.

When asked about the future, what Berge sees as key is keeping primary care at the centre. His focus is on ensuring that those practices that have chosen not to ‘integrate’ with the hospital will stay at the centre of this work, shaping how resources are shifted from secondary to primary care.

At the end of the conversation I was not left thinking the local hospital had taken over local General Practice. Rather I was impressed by the way the hospital had enabled integration to take place by working to meet the needs of the local practices, and ensuring practices remain in the driving seat.