Growth in primary care has been paralysed by misaligned policy. Angela Sharda speaks to a practice manager about how she rises to the challenge.
Q. How do you keep your practice thriving?
A. We provide high quality, patient- centred services and are often recommended by word of mouth. We also provide community engagement events. We merged with another practice in 2013 and have a service-level agreement linking us to eight care homes.
Q. What problems have you experienced along the way?
A. A key problem was engaging partners in large-scale change. We used quality improvement tools. We also implemented very small-scale change, sharing the outcomes at practice and partner meetings. We now have transformational partners who invest to save and take risks to maintain the high quality of care.
Q. How do you identify vulnerable older people?
A. Our practice worked with the clinical commissioning group (CCG) in developing a risk-stratification tool, which has been incorporated into our primary care quality dashboard. We will be using Emis Web for QOF frailty indicators from this month.
Q. How important is it to engage the practice population?
A. As a result of austerity measures our waiting rooms are inundated with patients who have a social need impacting their health. It is essential that we engage both patients and communities to develop pathways for population need.
Q. What are the biggest changes you have seen in your 30 years in the NHS?
A. Much of the large-scale change has resulted in complexity, fragmentation, a worsening in health and wellbeing and loss of organisational memory; building barriers between organisations as financial pressures become more intense. I believe 70% of large-scale change fails. Unfortunately, in the NHS we do not learn, we just impose further change. In the practice, we manage this complexity by using quality improvement tools and developing our workforce.
Q. What makes you proud?
A. Having a motivated, highly performing team who are passionate about the contribution they make every day to improving patient care. I get to work with others to test and tweak things to make a difference every day.
Q. What is the biggest issue you are facing?
A. Misalignment in policy is causing fragmentation and complexity like never before. We won a bid for premises- transformation funding in 2014/15, which we had to abandon because of NHS England rules on timescales, with a loss of £30,000. Encouraged by our CCG and area team we submitted a second, successful bid, at an additional cost of £20,000. Sustainability and transformation plans (STPs) are looming and we fear further change, and the prospect of losing the funding.
Q. What are you reading?
A. The Thirteenth Star by one of our GPs, Dr Simon Slyderink, following the death of his daughter from a brain tumour. It is educational and poignant.
Q. What impact do you think the election has had?
A. We will need brave, authentic leadership. But the most exciting thing for me was going to the polling station with my daughter Alesiha who voted for the first time. Her excitement and the turnout of young people gives me hope.
Sheinaz Stansfield is a managing partner and practice manager at Oxford Terrace and Rawling Road Medical Group, Gateshead, Newcastle, a locality manager for Gateshead CCG, practice representative on the governing body and practice manager representative on the Royal College of General Practitioners Northern Faculty Board.
