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  • Writer's pictureWendy Garcarz

The Four Elephants of Integrated Partnerships (enhanced services that make a real difference)

If the Department of health is serious about tackling health inequalities then why do they ignore services that would make a huge impact on those who traditionally get the poorest service?

I understand the thinking behind the enhanced service contracts that GPs are encouraged to deliver as it helps to focus attention on areas of clinical need. Enhanced health in care homes, early cancer diagnosis and medicines reviews are all valid issues that should benefit from GP intervention, and yet they miss the four elephants in the room!


Elephant 1. Mental health has taken a general battering over the last few years and if you or a loved one experiences this, the frustration at a 12-month wait (in some areas) for talking therapies must seem like a joke. Medication helps in a lot of cases, but there are also fears of stigma, dependence, and addiction related to anti depressants that make some people reluctant to take them. Coping mechanisms that are sustainable often come from CBT, EFT and other talking therapies that may take longer but offer sustainable results (although there is still some scepticism about these 'alternative' treatments). There are shortages of NHS therapists, but this is one area where the private sector can fill the gaps. Create a national register (entry by recognised qualification) then offer personalised budgets allocated by the GP to give quicker access to these valuable treatments.

Elephant 2. Dementia services are much improved over the last decade, yet I can't help but wonder the impact of dementia trained nurses working directly from General Practice for early diagnosis, treatments, social prescribing and information and support for struggling families trying to cope pre-diagnosis. There would be a significant workload shift away from GPs and a much better use of specialist voluntary organisations for their fantastic information and resources systematically signposted for those in need. There is also an opportunity to destigmatising the words and preconceived ideas around dementia and Alzheimer's. The long term solution for this is learning to live and accommodate the needs these diseases create until we find a cure for them.

Elephant 3. Health and Wellbeing Coaching is beginning with the extended roles that are being added to the primary care team as a way of managing demand. The cost of employing these individuals as part of the team and subjecting them to the difficulties of space to practice in overcrowded surgeries and the limitations of NHS appointment systems calls into question how effective they will be (cheaper doesn't always mean better value). A whole industry has developed out there of qualified coaches (many with clinical/nursing backgrounds) that could do this job quicker, more cost-effective and with better outcomes for patients. Again, all it would require is a national register and personalised budgets. In my experience these wellbeing coaches are better connected into their local communities and have excellent testimonials (real life success stories) that would encourage patients struggling with their health and wellbeing to see it as a viable solution.

Elephant 4. Solution focused co-production. Whilst not a service in itself it is the key to the most pressing priorities faced by primary care at the moment. If you need to make the money you have go further you need to pool the expertise and resources you have across multiple disciplines and reward the improvement they achieve. One of those measures is how you reduce patient visits to their GP because they are off working on a solution/ treatment/cure. If you are struggling to recruit because of the workforce deficit then think outside the box about who can help patients improve their health without doing 3-5 or 7 year training programmes. Don't assume that a tick box regime will show you if a service is improving, ask the patients that use it and let them tell you if they feel better, more in control of their condition, able to live their life again.

Some who read this will spend time deciding why these ideas cannot possibly work and put a whole host of barriers in the way so they wouldn't even be seriously considered. I have news for those people. What is happening at the moment is not working either so the question is not what have we got to lose but what could we gain if new and different solutions actually worked!

I have been providing leadership training and development for the NHS for more than 20 years and I have come to the conclusion that whoever decides on enhanced services menus needs to get out more. The problems that we face in the coming decade are not the same as they were a generation ago. We have got better at using health data and intelligence to plan for the future but if we fail to response to emergent need then all the data in the world will not help. Perhaps my next development programme should be in the art of elephant wrangling?

To discuss how to breathe new life into old strategies email me for a conversation

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