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Sunday 23 October 2016
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Harnessing hard work

As the saying goes, a problem shared is a problem halved and Harness Care Group has adopted this approach with its system of joint work with 21 practices

It’s not all doom and gloom for general practice. While there is no doubt that times are tough some are managing to thrive on a diet of teamwork and innovation.
One such success story is the Harness Care Group – where practices have put rivalries aside and come together so ideas and skillsets can be shared in what is becoming an increasingly popular option for survival.
Harness was set up in 2006 as a membership organisation with 12 practices serving 55,000 patients. In 2008 it became Harness Care, a provider company that runs on a not-for-profit basis. Harness Care, now has 21 GP member practices in Brent, greater London, with approximately 115,000 patients to look after.
Caroline Kerby, managing partner at Brentfield Medical Centre and director of strategic developments for Harness Healthcare, joins Carolyne Matthews, practice manager for GP Access Centre Harness Wembley and head of GP contracts, to give Management in Practice a glimpse into its busy world.
With 21 practices under one umbrella strong leadership is essential. Matthews plays a vital role in bringing all the practices together, working with 21 practice managers and numerous service managers to allow them to be united in one protocol.
As Kerby explains: “Carolyn supports the practices that Harness holds the contract for. Then Harness subcontracts out to the practices so that we do one lot of finance management, contract management, clinical governance assurance, then it is delivered out. The idea is that we do things once and cascade 21 times.”
Mathews goes on to say: “I think this works because of the practice managers. We have spent a long time building up relationships with those practices.
“I am trying to take away from people the pain of having to worry about claim forms and getting your money in. We are trying to get it so that money comes to one pot, and then we distribute it out. We worry about the governance. We worry about the training. Not the individual practices.”
Harness has tackled training head on. It wanted to make sure that career progression was an option under its guidance. With 115,000 patients across multiple sites and the possibility of some of the 21 practices working seven days a week and patients being referred to a hub practice for out of hours appointments it was felt that the front of house team needed to have similar training.
With such a vast patient base, “we wanted to know what the management structure would look like. We redesigned the traditional role into looking at the supervision end on the front line, what the operational need was, and what the strategic need was,” says Kerby.
Frontline staff are the back bone of any general practice and both Kerby and Matthews recognise this.
Mathews says: “They are the people we should be training up to become the future practice managers of primary care because they will understand the basics. That is definitely where I came from. At the end of the day, I feel the best way you can understand how a surgery runs, empathising with your surgery, with your team, and with your patients, is actually to start right at the very basics: filing, answering the phones and things.
“We want to promote practice management as best we can, because this is where you’re going to get the engagement because they have worked on the front line, they know what happens with patients. They understand the difficulties with appointments and telephones, and with protocols and policies, and the targets we have to reach, and the difficulties that you have with doctors and nurses.”
It’s not only practice managers that Harness wants to create it is also creating pathways to other healthcare professions. Harness recently had 10 frontline workers finish their healthcare assistant training. The aim is to go into nurse training.
The staff’s hard work and progression is rewarded with an annual award ceremony when they have completed their training. Hard work goes noticed by Harness.
At the moment Harness also has 30 apprentices coming through the ranks. They are local young people that were all previously unemployed.
Harness values all of its practices and sees that each practice’s opinion is vital to the survival of the membership programme.
On 4 July 2015, Harness held an event at a local park, Friends of Gladstone Park, bringing together the community and practices to help improve on patients’ understanding of health in the community.
It was a joint adventure between all practice staff and the patient participation groups (PPGs). Mathews says: “We had about 74 people in attendance [when organising the community event], so we had receptionists, doctors, nurses, practice managers, and a representation of two-to-three patients from each practice.
“We asked the patients: ‘What would you like us as a group of GPs, to do to help you in the community?’ It was the patients themselves who actually said: ‘We would like a fun day. We would like an event.’”
A “carnival” as Kerby put is what they wanted and this is what they got. The day involved, a cycling event, a talent show with dance groups and performing arts and people attending that pick fruit locally. It’s about having fun while promoting a healthy lifestyle within the Brent community.
Practices in the Harness group benefit hugely from sharing staff’s skills. When Kerby’s practice realised that one if its sister practices had higher children immunisation figures than any other in the group the practice manager Nhipa Rawal was called upon for advice.
It wasn’t just advice that was given but input in the practices. Rawal is paid to go round the practices and offer her valuable skills. This also extends to other members of staff doing the rounds and helping out.  “For example, in my practice my reception team leader is a really good smoking cessation advisor and a community trainer; she gets really good results so she now works at Carolyne’s practice on a Saturday and anyone from the 21 practices can refer,” says Kerby.
Kerby stresses: “We increasingly have staff being shared and people do not mind now. I don’t mind that Nhipa will come in and say, ‘well, you could be doing better with that and this is how we will help and support’.” Supporting each other inherently helps the patients. And in a borough that has a high number of immigrants who have to adapt to the way the UK general practice system works there is a need for constant communication between the Harness practices to keep everyone up-to-date and to share ideas that will help the practice and importantly the patients.
Harness hasn’t merged the contracts between the practices. As Matthews says: “All 21 practices are individual practices; they have their own working model. They are a business but we work as a team.” The organisation listens to its team, “we are a bottom-up, not a top down organisation,” says Kerby.
Local problems are tackled with the joint force of all 21 practices, using and creating a workforce that is fully capable. Kerby sums it up: “We are here, we are committed to this area, we want to make a difference, our vision is about creating healthy communities.”