Opinion: Why collaboration matters in Sheffield

Sheffield is the focus of the latest in our regional correspondent series. Clinical director of Townships 1 PCN and Primary Care Sheffield, Dr Tom Holdsworth, explains why collaboration is crucial to success. You can read the first article in the series here.

I have been working on collaboration between practices in Sheffield for almost seven years now.  

First, I was a ‘neighbourhood’ lead as part of a local clinical commissioning group (CCG) contract and then a PCN clinical director for a network in the Southeast of the city. 

In addition, for the last two years, I have been working as the chair of the 15 PCN clinical directors, a role for which we are fortunate to have local funding. Given the large amount of work for individual clinical directors in their own PCNs, the chair role works well because it gives additional time and support to help them engage with the wider system. 

I am also the Sheffield representative on the South Yorkshire Primary Care Provider Alliance, which is another route to influencing the system.

A lot of my time recently has been spent working on developing plans for integrated neighbourhood teams (INTs) as described in the Fuller Stocktake. It is interesting work because there is no clear blueprint that describes how to make it happen or even what a successful INT will look like. 

No road map

We recently held a city-wide event in Sheffield to engage stakeholders across general practice, community services, the voluntary sector, housing, dentistry, pharmacy, and social care to try and help drive forward this vision of integrated teams.

The absence of a clear road map – and because integrated care boards (ICBs) have signed up to the Fuller stocktake, which identified neighbourhood teams as a key part of the future – means that I have found organisations and stakeholders gratefully receive any offers of help to push this work forward.

In Sheffield, we have already spent time with PCNs co-creating a development plan for networks. Unsurprisingly, INTs are a key part of this plan. 

As my role covers the system, it’s important to understand where the work needs to happen. Some things need to be done at a hyper-local neighbourhood level, such as developing working relationships between frontline professionals. And others can be done at place or region level, such as providing support and guidance on data sharing and encouraging other services to work on a neighbourhood footprint. 

Of course, like most of the health and care system, ICBs are under great pressure. ICB staff have just been through a huge re-organisation, and now they must deal with efforts to reduce running costs.  

Focus on transformation

There is also the pressure to manage day to day running of the NHS while tackling the huge transformation that’s needed to deliver a sustainable NHS. A recent paper from The King’s Fund describes this as one where:   

• ‘The public (are) fully engaged in improving health and care, and patients and the public are seen as active agents in their care, with responsibilities as well as rights.’
• ‘Priority (is) given to investing in primary care and community services in order to anticipate people’s needs, promote independence and offer alternatives to hospitals.’

In my role, I need to help people focus attention on the transformation agenda, making sure that it doesn’t get lost in the noise of operational pressure. If we narrow our focus so that we only look at day-to-day demand, we might hit the target but miss the point. 

For me, this highlights some key strategic risks we face right now.  

The challenge

ICBs were created to take advantage of an opportunity to break free from the traditional purchaser-provider dynamic, create more joined-up care for patients and to work alongside a wide spread of partners to improve the health of whole populations. 

To manage this large and difficult agenda, they will need to quickly and efficiently engage PCNs – as well as wider primary care – and support them to focus beyond the immediate demands of access and day-to-day pressure. They will also need to avoid assuming PCNs can do this all by themselves. PCNs can’t do this alone, and they will need the rest of the system to bring resources and support to work alongside them. 

Given the large number of ‘moving parts’, not least in general practice, it remains uncertain whether we will manage the co-ordination needed for the challenge. 

Will organisations manage to move from competing for resources to collaborating for patient outcomes? Will the NHS really be able to collaborate beyond its usual comfort zones to help people live long and healthy lives?

It will be very interesting to see how the next few months unfold. Given the size of the challenge ahead and the huge cost – both in time and money – associated with setting up ICBs, it is important to take setting up INTs in the right direction from the start.