Partnership for change in Greater Manchester
By Adam Irvine, chief executive, Greater Manchester LPC
Local itself is an interesting concept. Local for us has to be viewed in the context of the changes to health in our area dictates. As a devolved system, Greater Manchester has been given the power to look at the health, social care and wider public services sectors in a different way. The rest of the country have Sustainability and Transformation Partnerships (STPs) focused on transforming healthcare in their areas. The Greater Manchester Health & Social Care Partnership is our STP, but we go significantly beyond the typical STP - not just to look at the integration of health and social care but to tackle, or at least contextualise, the wider determinants of health, and social and economic issues too. Our efforts are focused on both place and person to ensure we deliver the desired (and ambitious) outcomes of devolution.
There are seven big aims, tracked right across a person’s life course. Not all of them focus on health; two relate to early years development (low birth weight, school readiness), one is economic, but linked as a wider determinant of good health, there are three major disease outcomes (fewer early deaths from CVD, cancer and respiratory disease) and one on supporting people to stay well living at home into later life.
There are lots of opportunities for community pharmacy to contribute to these aims and they broadly align with the Community Pharmacy Forward View, since they reflect our ability to engage patients undergoing treatment as well as influence the millions of people we interact with to ensure the prevention and early detection work strands are strengthened appropriately. But we have had to think differently about commissioning health, and consider workforce development for whole teams to ensure they are prepared for the opportunities which arise from a greater focus on prevention and early detection.
We have also needed to build confidence in community pharmacy. Rather unfairly, poor commissioning of badly designed services historically in patches across our geography has led to inconsistent services. Complex for contractors, poorly understood by patients, inconsistent across our geography, they are impossible to advertise or market effectively. We are tackling this, because if we want pharmacy to be properly look after a cohort of patients with long term conditions, the system needs to be able to trust us to do so consistently. The will is there from both sides. Great. But we need the building blocks of good design and structure to help.
For us at GMLPC we need to consider many different versions of 'local'. As an LPC, Greater Manchester is local. Within that area, however, we must be agile to respond at locality level (typically unitary authority or council area), and at neighbourhood level (defined populations of 30-50,000 citizens – the magic number for accountable care structures nationally, it seems).
The colossal ambitions of Greater Manchester and the sheer amount of change underway has taken up the system's management capacity, but it has been time well spent. The Partnership spent a year in setup, sorting out governance and structures to support change, and a further year developing plans and strategies and ensuring they are genuinely co-created and deciding how to allocate funds based on the level of transformation needed. We are therefore only now in the delivery phase.
Things are moving quickly, although from a community pharmacy point of view we have not seen big changes yet. The single commissioning functions arranged between councils and Clinical Commissioning Groups are at differing stages of maturity; some of the ten local care organisations are more established than others. This has meant that, so far, most of our work has been at Greater Manchester level preparing for future changes.
We have been supported ably by our Health & Social Care Partnership colleagues in designing future commissioning options and platforms for easy activation by the emerging care organisations. We have also created a vehicle to allow us to both engage pharmacy teams and develop the various parts of the workforce who will need to operate differently, the GM Healthcare Academy. All of this – delivery, commissioning and service models, marketing are interconnected. Our real challenge is to balance it all appropriately.