Getting focused on your local integrated care system

Image of a woman with a long reel of paper to show Getting focused: understanding your local integrated care system

It’s essential that pharma professionals have a detailed understanding of their local Integrated Care System (ICS) to best focus their time in the new NHS structure.


Top 5 Takeaways

1 Primary Care Networks are the bedrock of any ICS.
2 Not all areas have established ICSs.
3 Pharma should map the structures of ICSs and the people leading within these.
4 Identify GP Federations that are business-ready and have a good track record.
5 Projects must alleviate workload pressure and positively impact the workforce.


The Primary Care Networks (PCNs) are the bedrock of any ICS; indeed, without a Foundation Trust (FT) and General Practice, engaged via the PCNs, there can be no ICS. This is why some parts of the country have ICSs that are only in the early stages of development, as lead FTs have only recently been agreed. This is also why ICSs can be at different stages of maturity.

Understand your local integrated care system

Where ICSs are developing, it’s essential to map the structures and the people leading within these, as well as unearthing those who have influence within the system. This is time well spent and you can do most, if not all, of the research online.

Image of the structure around an example integrated care system

The key to the model in figure 1 is that General Practice has come together to form four PCNs. They all work with support from the local GP Federation, which has been in place for almost six years and has a strong track record of delivery. It holds a subcontract from the local hospital for 24-hour ambulatory blood pressure monitoring as well as directly commissioned contracts with the clinical commissioning group for diabetes insulin initiation and titration, ear irrigation, PCN development and 24-, 48- and 72-hour ECG. It also has a track record of working with the pharmaceutical industry to implement projects that alleviate workload pressure and positively impact the workforce. If a project doesn’t deliver either of those it will not be considered.

Each month, the PCN clinical directors and manager meet with the Board of the GP Federation and to that they add the support of the Local Medical Committee. This ensures one strong and coherent voice within the health economy for General Practice. Everything is agreed within that meeting and people then attend the provider alliance, integrated care provider and ICS meetings to represent the views of General Practice.

“Each area of the country has parts of the system that are at differing levels of maturity and business-readiness, and you need to do your homework to establish that in the areas in which you work to ensure that you approach and engage with the right people”

What does this mean for pharma?

In this area at least two of your targets are likely to be the GP Federation and well as the PCNs. My suggestion, therefore, is that you take the time to draw the map for your local Integrated Care System.

For GP Federations, you are looking for those that are business-ready and have a track record of high quality and consistent delivery over time. In my experience, they are likely to engage quickly and want to get to delivery. They will see the relationship as two way and work with you, supporting you to support them.

Identifying GP Federations and PCNs

There is no definitive list of GP Federations so you may need to do some internet searching. Once you have the name of the GP Federation head to Companies House to search for it. The company record will give you some very useful information.

Overview: Here you can establish how long the Federation has been in business, which comes in handy when you move to the second tab.

Filing history: On this tab look for their most recent accounts. These will give you an indication of turnover and income over the last two years (you can go back further if you wish) and show whether it is fully functioning as a business. If the company has been running three or four years and there is no income to speak of, I would move on and find another target.

People: This tab will give you an up-to-date list of the Board of Directors, which provides you with a list of people to speak with.

Lastly, you may want to look at the Federation’s website to see what services they are running and whether they list what they have in development. Doing this prior to making an approach will help to ensure you target the right federations.

Identifying PCNs

For PCNs, NHS Digital has published Organisation Data Service (ODS) codes for all that exist. In addition to the PCN codes, ODS data will include information on the core partner relationships from practices to PCNs and the relationship between the PCN and a clinical commissioning group.

You can access the details of all 1259 PCNs via the website and can then map them to the local GP Federation. From there you can start to identify who the key people are in the PCNs. You may also then want to map the PCNs to the local GP Federation to see if any people overlap. It is not uncommon to find clinical directors and practice representatives in the PCN also on the Board of Directors of the GP Federation. You can also search for local PCN plans.

Who is my customer?

When it comes to the right customer you have to identify and access healthcare professionals who will be interested in working with you; please don’t assume that this will be everyone. Develop your own criteria to filter them. This might include identifying those who are business ready with a track record of developing and implementing value added projects. When working with them you then focus on developing key opinion leaders who will advocate the project for you. That process creates a pathway and service redesign, which embeds your product and service within it and makes the programme completely replicable. And don’t forget your project should alleviate workload pressure and positively impact the workforce, too.

By way of example, as leaders of PCNs, clinical directors may be the most obvious people to approach when looking to engage with your local PCN, but they have limited time and a significant volume of work, responsibilities and tasks. Consequently, even when they are willing, you are unlikely to find they have the time to engage with you.

I strongly advise you to establish who represents the PCN constituent practices instead. Where there is a GP Federation, identify who sits of the Board of Directors. Both groups may make for good targets for you.

Considerations

As mentioned earlier, check if the PCN and/or GP Federation are business-ready. Again, do they have a track record of project and service delivery and examples you can point to that suggest they will engage? Have you completed your research to build a clear picture of why this is the right group to engage with?

Another thing to bear in mind is that, COVID-19 apart, the majority of PCNs contain practices who have not had to work together in this way previously and are getting to grips with their own internal relationships. Also consider that many ICSs are in the process of forming and have only just got into the starting blocks. In a nutshell, each area of the country has parts of the system that are at differing levels of maturity and business-readiness. Do your homework to ensure that you approach and engage with the right people. If you do that well, I am confident you will watch your projects come to life.

Scott McKenzie is an Independent Management Consultant, working inside the NHS. He specialises in enabling the pharmaceutical, medtech and medical devices industries to deliver remarkable projects with the NHS. Go to www.scottmckenzieconsultancy.co.uk


Read more articles from the June issue of Pf Magazine.