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15 February 2017

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How to manage merging practices

Management in Practice spoke to practice manager Sue Wilkins ahead of the merger of her two Poole practices with a combined list size of over 20,000.

Parkstone Health Centre and Madeira Practice are expected to become one practice on 1 April this year once the Madeira premises and merger site is refurbished.

Q. How has the state of primary care effected this decision?

General practice in England is under significant strain, with many GPs and their teams caught on a treadmill of trying to meet pressures while lacking time to reflect on how to provide and organise care for the future.

At the same time, we are being asked to do more to relieve increasing pressure on emergency and out of hour’s services, support the development of better integrated care for people with long term conditions, and play a central role in commissioning.

Q. Why are your practices merging?

Initially the premises issues were the driving force behind our merger. Both the Madeira and Parkstone practices operate from buildings that are not ideal for delivery of modern primary care.

We want to be able to offer patients care from a modern, fit for purpose building with excellent facilities, and an integrated primary care team with excellent skill mix.

Individually we are successful practices with similar, patient centred approaches to care and a shared belief in making a continued positive difference to our patients. We felt it was the right moment to seize the opportunity to build and expand on our successes by combining our efforts.

Q. How did you go about it?

My first challenge was to apply for funding from NHS England’s Estates and Technology Transformation Fund (ETTF) to improve the premises and thus enable us to move into one building.

On securing funding, the next thing to concentrate on was to determine a common vision and approach to patient care. In theory, this appears straightforward. However, in practice this requires careful planning, not only in identifying the approach, but also how it will be delivered. Trying to do this as well as managing two practices has been extremely testing at times. A few of us have learned to live without much sleep working long hours while trying to do our day job.

When we started, we were already working closely together and sharing a practice manager. It was agreed that when the Madeira medical centre practice manager left, I would run both practices. This was with a view to us eventually merging .We all agreed that we wanted a more robust business, making it easier to maintain good care for our patients.

The focus was to increase and improve access for patients in the locality raising the quality of integrated care at the interface with primary healthcare services. We started to shift the balance from secondary to primary care, with improved integration and health outcomes, reduced fragmentation and strengthened, out of hospital NHS care.

Q. What advice do you have for other practice managers?

It has been a very steep learning curve and has not always been a smooth journey. There have been many challenges along the way, and there will be times during the early stages that it will seem a constant uphill struggle to make progress. Be prepared for this and be prepared to re-visit stages before moving forward. It is unbelievably difficult at times!

Everyone has to be prepared for lots of meetings, extra work, protected time is essential to be able to get through all the requirements. The HR process was probably the most difficult. As to be expected staff are deeply concerned about their roles and responsibilities in the new structure. You must make time to communicate and reassure the staff and inform them as early as possible about changes so there are no surprises. They are part of the change process and can offer great support and ideas.

Q. How can you help patients to understand a merger?

The partnership has plans to offer a more extensive range of services for patients in the future, but those patients are likely to notice a few differences in the short term as most changes will initially be in administration. It is important to convey to patients how the changes will take shape so they can fully appreciate what will change but also what won’t change when it comes to care provision and accessibility. The feedback that we have received so far highlights the importance that patients place on seeing the same GP, and they need to know that we will strive to protect this.

Keep communicating, widely and often, as under-communication will lead some to assume the worst. Be honest with your patients about the reasons for the merger. Produce a clear information sheet that explains who you are proposing to merge with and when, the main reasons why you want to merge, and what the main changes and benefits for patients will be. The next hurdle is to start actually achieving some of the promises made.