Greater Manchester - next steps in developing as an Integrated Care System

I have been a GP in Greater Manchester for over 20 years. During my time caring for patients, I have seen many system reorganisations; most recently, take responsibility for health and care being devolved to Greater Manchester.

In 2016, we were given the freedom to work together across the region to improve the health and happiness of our residents and we’re seeing the benefits: greater collaboration, contribution and mutuality, bringing partners together rather than redefining their differences.

The recent White Paper shares these ambitions and the creation of an Integrated Care System for Greater Manchester will formalise the arrangements we have been developing over the past five years.

We can only begin to respond to people’s needs when we consider them a person who is much more than their illness or condition, removing the organisational boundaries that try to fit them into predefined services and pathways.

Community

Covid-19 has had a profound impact on us all and communities have made rapid changes to their lives. What has been heart-warming is the way the community has come together. My practice found itself very quickly and efficiently working alongside other parts of the NHS and with local council, mutual aid groups and voluntary organisations.

This has involved anything from distributing computer tablets to older housebound and shielded patients so they could order their prescriptions online, to helping people stay connected by joining our Facebook live events led by our volunteer patient champions.

For the vaccine roll-out across Greater Manchester our PCNs have rapidly mobilised and we’ve been working with clinical commissioning groups, local authorities and voluntary organisations. People with all sorts of skills and experience have come forward to ask what they can do to help, from marshalling to vaccinating. It has been incredible.

All this is only possible when we have licence to establish partnerships and build trust. The pandemic has been a big test for us all, but it has also shown the strength of system partnerships and community connections.

I’d like to emphasise three opportunities in the next stage of Greater Manchester’s development as an ICS:

1. Creating new organisational structures gives us the opportunity to increase the diversity of leadership across the system, to strengthen the representation of BAME leadership.
2. Taking the opportunity to strengthen local clinical leadership - understanding the value of authentic clinical insight in population health approaches
3. The opportunity to unlock the strength of communities, building on the support and mutual aid we’ve seen grow house by house and street by street during the pandemic.

We have further to go and I believe it will help us when, subject to legislation, integrated care systems become statutory organisations.

Legislation will bring a greater degree of accountability and transparency and underpin the financial reforms we need to foster further integration.

But if we are to respond properly to the huge inequalities exaggerated and highlighted in the pandemic, our focus must be to rebalance a reactive health service.

We need to think differently – where we level-up places of greatest need, accept that social behaviour affects health and change the way we deliver services.

I would like to see a local, clinically led, personalised approach to population health and prevention - with our PCNs as the delivery units. But we need to keep people at the heart of everything we do, because systems like ours are based on positive relationships at a very local level.