Dr Ian Lawrence is the clinical lead for Team Up Derbyshire, taking up the role two years ago. He holds the posts of clinical director for integration and chief clinical information officer for Derbyshire Community Health Services (DCHS). He worked for many years as a GP in Derbyshire before moving into commissioning and then working for the community provider.
What is your personal vision for Team Up Derbyshire?
It is to bring together all the statutory and non-statutory services that support people in their own homes, where we go to them rather than them to us. A lot of people are doing that work at the moment but sometimes in isolation or without knowing what colleagues are doing. We want to see one team, with fewer people going in to people’s homes, and the people that do, having more time to understand individuals’ needs, wishes and aspirations.
Where does Derby and Derbyshire have an advantage over other systems progressing such work?
In Derby and Derbyshire, we’ve got really high-quality organisations working in this space – for example, DCHS, the community provider, is rated ‘outstanding’ by the Care Quality Commission (CQC) and 1/5th of our GP practices are rated ‘outstanding’, almost all the rest are rated ‘good’ by the CQC. The relationships between organisations are really good - you hear about some regions where they struggle to align and work together – but here we generally all get on well, we’re aiming in the same direction, and we’re in a good place.
What are the challenges?
Paradoxically, a potential problem of having really good organisations is that to become ‘outstanding’ they tend to have a strong culture and solid processes that are shared and owned within the organisation, and when you bring this together with another organisation, the two approaches don’t quite match, their foundations are slightly different. Whose approach do you go with?
Primary care networks (PCNs) have a large responsibility to make all this work – are they equipped for the challenge?
The short answer is ‘yes’. Primary care networks are relatively new, having only existed in name form for a couple of years. During Covid-19, their maturity rapidly developed - they have been very successful in helping roll out the vaccine programme and as a county we have been one of the most successful in the country, and that is partly due to the willingness of the PCNs to roll up their sleeves and get stuck in. An aim of Team Up is to support the PCNs to be really strong providers as part of a system that brings everyone together.
How has Covid 19 affected the development of Team Up Derbyshire?
Initially, plans were put on hold as the attention was elsewhere but during the first wave, as patients tended to stay away from services, it provided the opportunity to network and progress Team Up through Joined Up Care Derbyshire. I managed to gain support for the idea that PCNs are the people to lead Team Up. It’s probably worth saying that the quiet period didn’t last for long and the health and social care system is now busier than ever and people are really struggling. Team Up offers that glimmer of a solution in that there is the potential of additional capacity and a more efficient way of working.
Will patients notice the difference when the Team Up approach is fully operational?
The group of patients that we are referring to tend to be in their twilight years, possibly in their last year or two of life. Most people use most of their allocation of health and care spending at the end of their lives, so many people currently in this group will likely not experience any difference. It is the next cohort, over the next two to three years, who will experience the new Team Up approach.
What is the Derbyshire difference?
I think the big difference is the fact that we are bringing general practice in right at the beginning to lead and be central to the solution whereas quite a lot of other areas are bringing community services and social care together and almost leaving general practice to one side. However, I think we have to recognise GPs are the senior clinicians in the community, they are the glue that holds all this together.
Is this approach influenced by your own experience as a GP?
Of course, yes, the fact that I have worked as a GP has influenced this. I have stepped away from clinical practice now, and have been involved in commissioning and working for a community provider, so hopefully I can help bring the different strands together, bringing general practice into a system approach.
What are the next steps for Team Up?
There are two things which we are particularly focusing on at the moment. The first is moving general practice home visiting from being an individual responsibility to being a team effort. This makes sense through geography and having a small team to look after this more vulnerable cohort of people. The other element is in adult social care and developing a rapid response service so that we can get care rapidly to people in their home, to keep them safe and make them feel safe, rather than people previously all too often ending up hospital as a place of safety.
Away from work...
During this time of daily meetings on Teams, people have been noticing your background images…
They are mainly holiday snaps – they combine a love of travel, something that has been curtailed during these last 18 months, and an interest in amateur photography. Photographers might say they’re not very good but I enjoy it.
Favourites...
Holiday destination: I don’t tend to go back to the same place twice other than Wester Ross (north-west Scottish Highlands) where I’ve been most years since the age of four. When I was a medical student, I spent six weeks in Papua New Guinea which was amazing, we’ve had a couple of great family holidays in Iceland, which is stunning. Costa Rica, is so welcoming and their approach to the environment and social welfare is inspiring
Film: The Fifth Element (director Luc Besson)
Book: High Fidelity by Nick Hornby
Music: Pink Floyd through the years, but currently, Kae Tempest
Sport: Skiing, scuba diving – anything non-competitive!