GP leadership is blazing a trail in Camden
An award-winning consortium of Camden GPs is setting the standard for integrated primary and secondary care services which are led, delivered and managed by local doctors in general practice.
Mike Smith, John Horton and Jeremy Sandford are the three GPs leading Haverstock Healthcare (HHL) the consortium set up in 2008 to help local practices continue delivering services, but on a larger, integrated scale in order to compete with commercial healthcare firms. HHL is now owned by 26 existing GP practices across North Central London.
In May, the normally garrulous trio were stunned into silence when HHL won the 2014 BMJ Award for Clinical Leadership. Not that they had doubted the value of what they had achieved for the consortium’s 200,000 patients, or the positive impact of their integrated approach on other clinical services, but rather the realisation they had been recognised above other trailblazing projects and lifted onto a national platform.
The road to this point in time had been somewhat revolutionary, with patients and residents taking legal action against Camden PCT in 2009 to prevent a new GP health centre being established through a national private firm.
Mike Smith, Medical Director and CEO at HHL, says: “There’s been so much change applied to GP services over recent years, from that move in 2008 to develop GP-led poly clinics in every locality across the country, which felt very threatening towards existing local surgeries, to the latest initiative around urgent care centres and putting GPs at the front door of A&E services. There was a clear need for HHL to do things differently, so we started approaching A&E consultants and nursing staff to develop closer links on care delivered through GP practices.”
In the early days of developing the urgent care centre at the local acute trust there was some initial hostility, particularly from consultants and those providing clinical services. The old misperceptions and mistrust between secondary and primary care remained a considerable hurdle to get over. ‘Myth-busting’ is the term they use to describe the process and a lot of time was invested in developing relationships. HHL were determined not to operate as a bouncer at the door of A&E but work with hospital colleagues to direct and redirect patients where necessary, but always towards a destination of care.
Since opening, the centre has managed to treat around three out of every five patients and redirect one in five, leaving only one in five patients actually needing treatment in A&E. HHL’s relationship with the Royal Free London NHS Foundation Trust, where the centre is based, went from strength to strength and when the PCT ran-out of funding halfway through the original pilot, the Royal Free stepped-in to commission the GP consortium directly, rather than lose its urgent care centre.
John Horton, HHL Chairman, says: “We put our success down to a determined vision for our patients, embracing an authentic, front-line leadership style that accommodates the fact that we are effectively a collection of small businesses with existing leaders who must be allowed to lead for their patients. So, building and believing in the strength of relationships is essential.”
The belief that general practice is currently balanced on a precipice, and the principles which underpin this flagship of the NHS healthcare system need to be rescued, is firmly held within the consortium. Those at the helm of HHL feel passionately about supporting GPs to lead and deliver care that is naturally the territory of general practice. They have a history of leading and developing general practice solutions to meet the needs of Camden’s patient population. One area they are scoping with the CCG, involving the consortium’s GPs and nurses along with the Foundation and Community Trust, is a revamped service to respond to a particularly challenging diabetes problem in the borough; HHL will provide the leadership ‘glue’ to keep all the component parts together.
Jeremy Sandford, Director and founding member of HHL, explains: “None of this is about meeting targets. We decide what matters to patients, with their input. Patient groups attend all our meetings and work as a true resource for the service, not as a tick-box.”
So, what next for this busy GP consortium? All agree that general practice remains tricky and challenging and they are constantly looking at where they can fit in, bridge service divides and lead and develop even better care, collaboratively. Both the opportunity and the challenge is to grow in size and scope, but with integrity.
Mike Smith explains: “Our aspiration for the future is to look bigger and wider but still safeguard our relationships with patients and our acute healthcare colleagues, while supporting and developing resources. We now have the opportunity to deliver general care, not just primary care, together.”
FMLM is proud to support the BMJ Clinical Leadership Team of the Year Award and congratulates Haverstock Healthcare on their exemplary achievements in this field.