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Friday 24 May 2019

That was quite a fortnight. Within the first few days I’d become a pensioner, a grandfather (sort of), and then the CCG had received applications from 13 Primary Care Networks (PCNs), complete with 13 named clinical directors, by the specified deadline of May 15th. Only one Somerset practice has elected not to join a network. All the PCNs were subsequently authorised by the CCG the following day, with one or two caveats and clarifications requested. Well done, everybody. That’s quite a feather in Somerset’s cap, and from talking to colleagues elsewhere, puts us ahead of many other areas in the country. That, I suspect, was the easy bit.

Thanks to everybody who sent me birthday wishes. I had a weekend of celebrations, with various meals and family gatherings over a three-day period. The last guests had only just left when our lovely Labrador, Maia, went into labour and produced six puppies, three black and three yellow. I’m a proud and doting granddad, and I hope you’ll forgive a strand of Andrex* running through this bloggage. Mrs. Chair and I were up through the night, and the characteristic smell of amniotic fluid, empathetic breathing and catching little slippery things brought back a whole heap of memories from labour ward days. There are some striking differences from the human neonate, however.

I’ve been plotting the weights of Archie, Bernard, Percy, Fudge, Peggy and Doris, and from day one they’ve taken off like scalded cats (or breastfed puppies), doubling their birthweight within the first seven days. That’s 3kg of total added bodyweight in a week, courtesy of mum’s milk, and impressive by anybody’s standards. It makes one wonder why human infant feeding (even for a singleton) can appear to be so complicated and fraught with problems, that I for one, find one of the biggest heartsinks. Maybe when all this is over, I could take Maia into work, not as a PAT (pets as therapy) dog, but as a feeding specialist- especially as I can’t seem to find one anywhere else. I found myself prodding a baby in the surgery earlier this week and struggling to hide my disappointment. It wasn’t just its Christian name (guess the first letter?), but it hadn’t got much above its birthweight, was distinctly lacking in fur, and was far, far smellier. I was delighted to hand it back to the parents, telling them what a lovely humanoid they’d produced, whilst inwardly burnished with a new and irrational disdain.

Last week I attended the ‘Fit For My Future’ (FFMF) Health and Care Professionals Group in Bridgwater. This had been previously branded as the Whole System Clinical Strategy Group, but the purpose is essentially unchanged, to provide clinical oversight of the various workstreams. The STP and FFMF groups have been brought under a single structure, which is meant to simplify the process and hopefully avoid duplication. Certainly, I go to quite a few groups where many of the same characters are in the room, but in different combinations, and it’s not always been apparent as to how the different groups fit together. This is particularly true where groups might change their focus. The Alliance Development Committee, for instance, was set up initially to oversee collaboration and then merger between Taunton and Somerset Trust and SomPar, but senior figures from Yeovil and the County Council are now also in the room, and so inevitably the group has a different and more system-based focus, but without the CCG being present. I’ll admit that I’m still struggling to get my head around the new ‘simplified’ STP/FFMF structure, although this may be in part due to sleep deprivation, or the garish and impenetrable colour scheme when I saw it presented in slide form. I’m going to have another look soon, perhaps preloaded with 900mg of aspirin and dark glasses, unless I can find a legible copy in black and white/grayscale. It can’t be that complicated.

Back to the networks. We have been keen to emphasise to anybody who’ll listen, and a few who typically don’t, that the principal purpose of the PCNs at this early stage is to shore-up Primary Care, and it will be some time (years) before they are ready to take on significant extra services in addition to what is already specified in the contract. The Clinical Directors will be thinking how best they can link with practices within their networks. Meanwhile the acute trusts and others have been thinking hard about how they are planning to reach out to the PCNs. Having spent the last ten days watching the semi-Brownian chaos of six blind puppies stumbling around hoping to bump into a teat, clambering over and under each other as they go, I’m hoping that we’ve done sufficient groundwork with others to help develop a cohesive structure, and that making new connections will be easier as a result.

Stuart Walker, medical director of TST/SomPar, attended our GP Board meeting last week, to discuss how the merged TST/SomPar Trust boards had to submit a business plan that included a scheme for clinical service delivery. The Trust were keen to link with the new PCNs and we discussed the evidence from the Nuffield Trust paper: ‘Shifting the Balance of Care’, which described which system approaches were cost-effective and which increased costs (guess which category Urgent Treatment Centres and many of the other ‘cunning plans’ imposed from on high fall into?). The TST/SomPar community directorate will be divided into four localities, each with a ‘relationship manager’ (RM) who would liaise with three PCNs. The RMs would each have different briefs, depending on which acute local trust the PCN was more aligned with. It was suggested that trust staff could be involved in quality improvement activity being undertaken in general practice.

We also spent a large chunk of the meeting discussing how best the GP Board could engage with the group of Clinical Directors. The GP Board are hoping to host an evening event towards the end of June and invitations will be coming out shortly. The meeting was curtailed when the conference call linking us with Glasgow, Castle Cary and Cornwall cut out automatically after 180 minutes. None of us had the energy to reconnect at that stage, so we called it a day. Whoever had the controls of the LMC Twitter feed tweeted later, with not a hint of sarcasm, that the ‘three hours had flown by’. Exactly.

Last week I was invited to the South West Public Health meeting to talk to them about Primary Care Networks from the Primary Care perspective. They are also keen to make contact. I was fourth on the bill after presentations from the local NHS England team and various Public Health specialists talking about population health management. They were a very friendly and receptive bunch, and I hope appreciated my candour when outlining what GPs felt the PCNs were principally there for.

Colleagues may have noticed a new variety of pop-up appearing on the EMIS system recently. About 85 of us jemmied and jammed our way into a room at the Holiday Inn on Tuesday evening to learn more from Dr Miles Carter, an Oxfordshire GP and the driving force behind Qmasters, who designed this add-on for EMIS (it can also work with System One). Despite sitting on each other’s laps, the lasagne running out and missing The Archers, it turned out to be a useful evening. It was an impressive and pacey presentation, and Qmasters would seem to be a ‘Good Thing’. It has been commissioned by the CCG for a year initially, principally to help SPQS practices returning to QOF, but available to all. Although principally aimed at improving QOF performance, it also contains patient safety, diagnostic information and many templates that will help in a number of situations, whilst improving the clinical recording of consultations. We are aiming to get Miles back again later in the year for a further session, but in the meantime I would strongly recommend everybody has a peek at the short and succinct training videos on the website.

This Wednesday was rammed with excitement. It started with a meeting of the Neighbourhoods Board, held in the meeting room at SomPar’s Foundation house in Taunton. We were seated round the perimeter of the room in capacious armchairs, reminiscent of those meetings between western diplomats and middle eastern potentates. It was chaired, brilliantly as ever, by Trudi Grant, the Director of Public Health, who did a great job of keeping us awake and engaged. This group has oversight of the way in which neighbourhoods and the networks develop and start working with each other. Whereas I always think of the 13 Primary Care Networks (PCNs) forming the framework or skeleton around which the 12 neighbourhoods (East Mendip and Frome PCNs will share a ‘neighbourhood’) will emerge, the local authority perspective is that the PCNs with ‘coalesce’ around the neighbourhoods, presumably as some sort of exoskeleton.

It occurred to me that the last time I’d been in that exact geographical location was 32 years ago, when I would have been in the treatment room of the dermatology ward as part of Cheddon Road Hospital, performing biopsies and excisions on ward patients and others sent from the clinics. What would we give for something like that now?

I spent the afternoon talking to the ST3s at Musgrove. The first session was on ‘Error, Fault, and Negligence’. I’d borrowed Harry’s slides that he’d prepared for a similar talk aimed at paramedics, but soon realised I’d collected enough of my own cock-ups and calamities over 30 years to illustrate much of what needed to be covered. I was surprised to see that despite the sunshine, they all returned after tea, when we discussed what the LMC is and does, before finishing with an update on networks. They were an engaging bunch, and I’m hoping that at least a few of them will want to come along to an LMC meeting to see more of what we do.

After that it was a hop to Bridgwater in time for the Somerset Primary Health AGM. Apart from the standard AGM fare, Ian Creek gave a few words in his new role as MD of SPH, and the evening concluded with a presentation to Jon Upton and Emeline Dean who were standing down as directors, and the (hoarse!) Madam Previous Chair, Sue Roberts, who is stepping down from her role as non-executive chair of SPH. Sue has been a giant in the Somerset system leadership for many years, particularly when she was leading the LMC from her chariot- and we all owe her a huge ‘thank you’, and hope she can now, at last, enjoy a well-earned retirement. She won’t sit still though, obviously.

Must go. Archie’s gone AWOL again.

Grandpa Nick

*other brands are available, but it’s not the same

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