Learning from practice

CITY & HACKNEY ELIC

WHAT IS ELIC?
ELIC stands for “East London Integrated Care”

ELIC is an innovative new social enterprise in East London, registered in July 2006 under the Industrial and Provident Societies Act 1965 with the objective of supporting GPs and other primary care staff to work together to develop high quality services.

ELIC at present covers the area served by City & Hackney Teaching PCT, but will extend into other Boroughs in East London in 2007

WHO’S PART OF ELIC
ELIC covers a population of 212000 people registered with 34 practices in City & Hackney. ELIC is actively supporting the PBC Consortia in City & Hackney

ELIC is a membership organisation – it has 201 GPs, Practice Nurses and Practice Managers as members as at the end of August 2006

WHAT ARE THE KEY FEATURES OF ELIC?
ELIC is
• A not for profit organisation – a Society for the Benefit of the Community
• An umbrella organisation to enable GP practices to work together and collaborate
• Led by local GPs and other primary care clinicians
• Strengthened by community ownership and participation

WHY WORKING TOGETHER?
Most GP practices are small – the largest in City & Hackney has 14000 patients but many are between 2000 and 7000 – and this can make it difficult for an individual practice to develop the kind of services needed by patients.

In the new NHS it is becoming increasingly important for GP practices to work closely together:
• The government’s vision and policy for the future of primary care will be easier to achieve through a larger collaborative structure than by individual practices working on their own
o It is becoming increasingly important for practices to share services to make the best use of scarce staff and resources and ensure first class clinical quality
• A collaborative structure provides a support and developmental mechanism to local practices - enabling them to work together, share good practice, agree common standards and provide mutual support to each other to deliver the best possible services to their patients. Working in this sort of environment is also more attractive for new staff coming into general practice rather than having to set up and work in isolation.
• A collaborative structure also makes it easier to engage in partnership working with social services and voluntary and other organisations, as well as with hospitals, and therefore provide the kind of “joined-up” services which patients need. It makes sense to link and deal with one organisation and one way of doing things, rather than 50 individual practices.
• Practices are now responsible for purchasing (commissioning) hospital care for their patients
o Practices need to collaborate to successfully shift services and resources into the community in order to share and provide new clinics – a “critical mass” is needed if these are to work effectively
o By working together and representing a large group of practices and patients, practices are likely to have much greater influence in their discussions with secondary care colleagues – and fragmentation through different service models and standards can be avoided
• A small infrastructure working behind practices will support them to provide better services to their patients and tackle health inequalities
o By working together to common protocols and processes for the management of certain conditions, health inequalities can be reduced as practices will be providing the same services to the same high quality standards

This isn’t about merging practices – individual GP surgeries will remain as the “front door” to the NHS for most people. But what will change are the working arrangements “behind the scenes” which will improve services for patients and help practices to continue to develop and thrive

LOCAL DIRECTION
Local GPs and other primary care clinicians are “in the driving seat” of ELIC. As the people who plan care each and every day, they know what the problems are that need to be tackled locally and how standards could be improved. ELIC provides them with the framework to work together to address these

Local people will also have a strong say in ELIC and help to shape the way that services are developed and provided. Because people have a long term relationship with their GP, they will be keen to get involved and have a say, providing a key role as a “critical friend” about service developments and the priorities of the organisation

The management team of ELIC will be accountable to an elected Council made up of local people and clinicians to ensure that this strong clinical and user direction is actually implemented on the ground.

WHAT WILL ELIC DO?
As well as setting up the organisation, over the next 6 months ELIC will develop new services and pathways for
• People with Urology problems
• Women with Gynaecology problems
• People with long term conditions such as heart failure, asthma and lung disease
• People with ENT problems
• Antenatal services
• Minor surgery

ELIC will also
• be working with its constituent practices to develop primary care services
• be setting standards for improved communications between GPs and hospital staff

WHAT’S THE ORGANISATIONAL MODEL
ELIC will be both a mutual organisation -which means that it is led by its constituents: GPs and primary care staff – and a social enterprise whose objective is not to distribute profits but to reinvest any surpluses it makes to improve the health of the population in City & Hackney. The organisational form is a Society for the Benefit of the Community (BENCOM).

ELIC will be governed by a Council, made up of representatives of local GPs, Practice Nurses, Practice Managers and the public. Its day to day operations will be directed by 3 GPs and a Chief Executive. There is a strong membership body of all local GP practices who will work with their representatives to shape what ELIC does. The same goes for the Practice Nurses and Managers

There will also be a community forum made up of local people who are already working closely with individual GP practices and who link with the public representative on the Council to shape ELIC’S direction. Developing the public membership is one of the priorities for the first year