Shared purpose
“Having a shared vision and purpose is key. If you haven’t got that then you haven’t got a chance of a successful collaborative venture,” explains Dr Nick Jackson, clinical director for Selby Town Primary Care Network (PCN). For the PCN, this has been mission critical and enabled the network to redirect resource to where it is needed in the community.
The network unites four GP practices in the North Yorkshire town of Selby to look after a population of 49,792 people. It has joined forces with the local community services provider to focus on improving care for vulnerable residents in care homes. This joint mission has broken down traditional ways of working and fostered a real sense of collaboration.
For Dr Fiona Goudie from Sheffield Health and Social Care NHS Foundation Trust, aligning organisations around a common goal is vital. As one of 12 national early implementer sites testing and delivering the Community Mental Health Framework at place, providers there are taking a population-based health inequalities approach and focusing on improving mental health access in the PCNs that support the populations with the highest need.
The collaborative took advantage of the opportunity to partner with the voluntary sector to employ community connectors and health coaches to tackle the integrated mental and physical health challenges for people with serious mental illness
“This has established a vision that everyone can sign up to,” Fiona says. By creating a collaborative defined by purpose, rather than by traditional hierarchical structures or organisational boundaries, partners have removed silo working and reframed the conversation to focus on serving the population of Sheffield.
They worked within the PCNs to increase the mental health offer at the front door of GP services, offering a way into the mental health system through a more personalised and trusted approach. Rather than being referred to an anonymous clinician in secondary care and having to be seen in a secondary care setting, patients can access mental health services through their nominated GP and be linked up with support from within their local community.
The collaborative took advantage of the opportunity to partner with the voluntary sector to employ community connectors and health coaches to tackle the integrated mental and physical health challenges for people with serious mental illness (SMI). They used the apprentice scheme to fund ten places on the new clinical associate psychologist programme (graduate psychologists who are trained to master’s level), increasing capacity to deliver psychological therapies, and brought in specialist mental health pharmacists to support primary care and focus on medication reviews and deprescribing.
As a result, between June 2020 and August 2021, more than 1,900 patients with complex needs and trauma were seen and provided with wraparound clinical and social support closer to home, delivered by trusted members of the local community. By focusing on the most deprived areas, the collaborative has doubled the mental health access rate for black, Asian and minority ethnic communities – from 11.6 to 22 per cent.
The collaborative took the system narrative and facilitated partners to work together to improve and deliver the best mental healthcare and support for the residents of the city. For Dr Goudie, structure has mattered less than purpose. The focus on a common goal has enabled greater flexibility to apply bespoke solutions with bespoke partners that best meet local needs. This includes working with the voluntary sector on highly targeted pieces of work for PCN areas in Sheffield.
For the Bath and North East Somerset, Swindon and Wiltshire (BSW) system, this fundamental point on shared purpose has also been a gamechanger. There, three acute trusts faced with long paediatric waiting lists worked together to reduce waiting times for children ready for surgery. They ran a series of all-day surgery lists over three weekends in two theatres within Salisbury NHS Foundation Trust, taking patient from all three acutes – including the Royal United Hospital Bath and Great Western Hospital NHS Foundation Trust.
“Leadership becomes a lot easier when you have a compelling vision; the problem among the three trusts was very easy to describe and morally compelling to solve,” explains Dr Duncan Murray, deputy medical director for NHS Salisbury Foundation Trust.
“We had lots of children waiting a long time for surgery, these were vulnerable children often with poor dental health.” He goes on to say that “there was the sense of inevitability that whatever blockers got in our way we were going to navigate them, and ultimately we were going to realise this vision of getting these children treated by working together in a way we hadn’t done before.”
Anna Field, the deputy director for commissioning for BSW, highlights that although the teams didn’t know each other very well, this became a priority for all of them, and it “drew people together.” Operational managers within the three hospitals spoke regularly and worked together to resolve issues, such as how to identify and book patients from across the patch and setting up and agreement to share equipment from neighbouring providers due to the large patient list sizes.
As a result, the partnership between the three trusts reduced the total waiting list by 47 per cent for ears nose and throat (ENT) and 44 per cent for oral surgery, of which there was a 78 per cent reduction for those who had been waiting for more than a year for ENT surgery.
Shared purpose is a galvanising force for partnership working on any scale, however many parties may be involved. Take Greater Manchester, for example, where politicians across the political divide rallied behind the city-region’s devolution deal. “This meant that we were able to work across geographical and political boundaries in common interest,” Sir Richard Leese, the newly appointed chair of the Greater Manchester Health and Care Partnership, told us.