Collaboration at Scale

March 27 2018

The focus of much the discussion around GP at Scale was initially based around the organisational structures being set up to deliver care to larger populations and what size these worked best, whether 30, 50, 100000 or bigger. As a result, all sizes of GP partnerships and organisations exist across the country with, as the Nuffield Trust RCGP survey described last year, most GPs working in several organisations of different size.

Following this some of the focus has moved to look at the other domains Donabedian described for healthcare systems.  A range of processes are being used to try and deliver care more effectively and efficiently ranging from integrated teams, new models of consultation and a range of health care professionals delivering care.  Now too the outcomes are being considered that new ways of working deliver for both those receiving and delivering care, both the positive impacts on improved access and decreased workload and the challenges of providing quality primary care at scale including how to maintain holistic person-centred care and continuity.

However, the formation of formal larger organisations to deliver care at scale isn’t the solution for all of primary care and for many scale is developing in a more informal way across decentralised networks.  From around the country more stories of informal collaboration between practices are emerging with small consistent actions being carried out across a range of organisations to improve the care of patients and the workload of clinicians.

Networks are forming online using social media to share ideas problems solutions between clinicians, as are new connections between practices and groups to share workforce resources, including those with financial, clinical, IT and organisational development skills on a sessional basis.

The power of informal networks to work at scale was most clearly demonstrated to me when a practice nurse’s illness in one area just before Christmas risked patients going without dressings changed before the holiday.  By sharing their need for assistance on social media, appointments were found in local practices to share the workload together.

Perhaps this level of collaboration at scale is normal to you, or perhaps sharing appointments a step to far.  Either way, please share your experiences on the online network or become involved as we develop our local networks and champions.

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