It is a long time since I have written about “co-opetition”. I was pregnant with my first child and trying to teach Masters level business students about the new world of strategy. The teaching team decided upon the word to reflect the need to compete and collaborate in parallel. The concept is still relevant and being deployed today across the healthcare space. The most interesting application is in the NHS across federations of general practice.
The NHS is pursuing some big policy agendas around integrated care and chronic disease management in the community. Sadly, many GPs opted out of chronic disease care in the early 2000s. This is the legacy of GP contracts which became so specific that anything not in the document was deemed “outside of my responsibility”. The consequence was that just as the tide of diabetes reached the UK, significant numbers of GPs stopped treating it in the community. It became the prerogative of endocrine units in hospitals. GPs became de-skilled in even basic diabetic management.
Now the tide is turning. The NHS is actively funding multi-disciplinary care pilots and integrated hospital services in an attempt to make ends meet. Many GPs, languishing in the backwater of reactive acute medicine, need to be re-skilled to take up care opportunities which now have some funding attached to them.
How do you make this happen quickly? The NHS has introduced some local performance measures which only kick in if GPs in an entire catchment reach certain targets. The NHS has funded the creation of diabetic pathways, patient management systems and training to support the initiative. In addition, networks of 4-5 GP practices are brought together to compare outcomes and work on mutually beneficial opportunities. Within months the worst performing GP practices are back on the league table due to the subtle peer pressure the system has created.
These processes have generated relationships which are now being used to pursue more aggressive and locally generated initiatives. This is the background to the rise of GP Federations and very large merged GP practice groups. The Vitality Partnership in Birmingham is held up nationally as a proactive group with nine sites now under shared leadership. Back end functions and even incoming phone bookings are centralized. Clinical expertise is being deepened and led by GP experts in various organ systems. Integrated care initiatives are mushrooming and will continue to do so now that the group has received a Vanguard contract to pioneer increased multi-disciplinary care in its region. North West London GPs are actively working through the model to see if this approach is for them.
Other groups and regions have taken a different approach. In Tower Hamlets in London, the GP Federation of 30 practices is explicitly into co-opetition rather than merger. Together they put a submission to the NHS to receive a Vanguard contract for multi-disciplinary care. On their team of bidders were local hospitals and universities, not for profits and the interested GP practices. This is a very different world from the silo bound health sector so typical around the world. It is akin to the model in Adirondack in the USA which is more than two years into delivery and producing staggering success.
The driver of this change is of course the failing business model of general practice. In the NHS and other parts of the world, funding streams have not remained abreast of the demands of chronic disease care. Consequently, many parts of the system would prefer to hive off that activity to someone else. Integrated care is designed to address these motives and create new models of care which maximise access to patients from a re-engineered health system within existing budgets. Sure, some parts of the system will lose funding, other parts will gain both funding and responsibility. Either way, the quantum is fixed but the outcomes in terms of patient flow and satisfaction are changed.
With all of the discussion regarding the roles of Divisions of General Practice (where they still exist), Primary Healthcare Networks (which will exist very soon) and the recently autonomous health and hospital services, perhaps it is time we took a closer look at models of collaboration which change the world for the better. Our institutions are generally much larger than the NHS and US equivalents so that will add to the challenge, but the outcomes seem to be so superior, the dialogue is worth starting.
Tracey Johnson, General Manager, Inala Primary Care