Liz Carter is a Locality Manager for NHS Horsham and Mid Sussex CCG. In a guest blog this week she writes about her experiences in trying to develop collaborative working between practices in Haywards Hearth and Burgess Hill – and how she was supported by Ben Gowland and the Ockham Healthcare approach…

I joined both the NHS and Horsham and Mid Sussex CCG in September 2016, having spent most of my working life as a Partnership Manager in a Local Authority. I was to be the new Locality Manager for Haywards Heath and Burgess Hill. At first, I was keen to get started on introducing the Primary Care Home / primary care at scale approach to Haywards Heath and Burgess Hill.

The plan seemed simple enough: bring groups of practices together (with a combined population of between 30,000 – 50,000) and enable them to work collaboratively to address the health needs of the local area.   The practices would benefit from the potential to address common workforce and capacity issues, share best practice, and look at how the new extended access requirements could be met.   The plan also seemed to make perfect sense. This collaborative approach would enable the newly established Communities of Practice (extended primary care teams) to wrap around the practices, providing a joined up approach to health and wellbeing which would ensure that the patient receives the right care from the right person in their town, and GPs could find some breathing space.

And then reality hit. What looks like a sensible plan on paper isn’t necessarily perceived in quite the same way by all!

Ben Gowland was employed by the CCG to support the process of collaborative working and was asked to support the practices in Burgess Hill. When I met Ben I was under some pressure to describe how the towns I work with were planning on meeting the extended access requirements, so I thought that would be the hook we would use to engage the practices. After all, they needed to do it, we needed them to do it, and Ben could help us scope how they’d do it. Again, simple and sensible.

But no, it appears that’s not what works. Ben is against rushing in with ready-made solutions. He avoids the straight forward, ‘here’s the pressing problem and this is the solution’ approach. I learnt that we needed to start with what matters to the practices, not what matters to me. We needed to listen. We needed to understand. We needed to know what they wanted to achieve. We needed to know how they thought they could achieve it.

So how do you do that? We met with all of the practices on an individual basis and talked and listened and reflected back to them what they had said.   We then identified the common issues the practices were facing and provided an opportunity for them to share these issues with their neighbouring practices. This process of building trust and relationships takes time but can’t be bypassed, whatever the CCG deadlines.   The practices met and shared information, and in so doing built new relationships. They considered the common issues they were all facing which gave them a reason to work together. They looked at who was best placed amongst them to drive this work forward and together they chose one Partner from one of the practices and his Practice Manager (paid from the CCG locality budget) to draft a business plan for the town.    Whenever there was dissent or concern, they were brought back to the common issues they had all agreed were troubling them.

During this time I regularly reminded Ben of the CCG deadlines and felt quite anxious about the passing weeks and months. But the end result is that the town identified its own issues, found a common reason to change (not one necessarily based on CCG priorities), identified people within the town to drive it forward, and a way to keep plans on track when there was disagreement. And you’ll never guess what? One of the issues that was highlighted and resolved by the town was how it would address the extended access requirements!

And if you’d like support with introducing collaborative working, don’t forget our Podcast this week which you can find here and information about a new training programme we are running with Kaleidoscope Health which can be found here.