About Wolverhampton City Primary Care Trust
Wolverhampton City PCT comes under the West Midlands Strategic Health Authority (SHA) and employs around 2400 staff. It receives an annual revenue budget from the Department of Health, which was more than £450m for 2008/09. In partnership with local communities, local organisations and other agencies, it decides how this money is spent to meet the health needs of a local population of around 239,000, whilst also achieving national and local targets to improve the city’s health and improve healthcare services.
The PCT is responsible for:
- improving the health and well-being of the community
- commissioning a comprehensive and equitable range of high quality responsive and efficient services
- providing high quality services
- integrating health and social care.
The PCT provides community healthcare such as school nursing, community nursing, health visiting, mental health, contraception and sexual health, hearing services, chiropody, rehabilitation, dental care, addiction services, speech and language therapy, physiotherapy and occupational therapy. It also supports primary care providers.
Partnership working at Wolverhampton
The model for future partnership working was set by the previous healthcare trust, in a document produced jointly by management and staff side in 1997 ‘Developing real staff involvement.’ The main drivers to partnership working were:
- a desire to move from the confrontational style of employee relations at that time
- a desire to go beyond the simple recognition agreement, which assigned roles to management and staff side, without commitment from either side to joint working
the Department of Health’s publication ‘NHS Task Force report on Staff involvement’, which encouraged a more consensual approach to employment relations
- Wolverhampton went on to be the first NHS recipient of the Department of Trade and Industry’s (DTI) ‘Partnership at Work fund’ award.
Embedding partnership into the organisation’s culture
Partnership working is firmly embedded, both in the culture at Wolverhampton PCT and in its consultative structures:
- the PCTs negotiating committee is a formal subcommittee of the trust board
- there are seven local consultative groups (LCGs), which are sub groups of the Trust Negotiating Committee (TNC) Membership is made up of management, staff side and staff representatives
- since 1999 a staff side representative has had a place on the trust board
- there is staff side representation at Provider Board, and Professional Executive Committee (PEC) levels
- there are six weekly informal meetings between staff side and the managing director of provider services
- there are regular meetings between the staff side chair and the PCTs chief executive.
There is a key role for partnership working in the development of the trust’s HR policies and procedures. All HR policies and procedures are written and reviewed via the HR policy group, which is jointly led by HR and staff side. The membership of the group is made up of HR managers and advisors, staff side representatives and operational managers attend as and when the content of the policy requires their input and as directed by the group itself.
"By working in partnership with HR managers on the policy group, it means that staff side can have an immediate input into decisions that have an impact on their members. This saves not only time but allows negotiation and instant feedback. At the end of the meetings everyone can confirm what has been agreed that any grey areas can be identified and decisions made on how to progress"
Donna Willis, deputy staff side chair and joint lead of HR policy group
"Through this group we share the content of all policies and procedures with managers, staff side representatives and staff through our LCG’s prior to final ratification via the TNC. This process develops a much greater sense of ownership for the policies and procedures by all staff in the PCT."
John Brown staff side chair
Partnership agreement
Wolverhampton PCTs partnership agreement is in the final stages of review. It is to be approved in April 2009 and will be posted on the trust’s policies and procedures page on the staff intranet.
Partnership working is implicit in all change management procedures, with staff side representation at all levels. Embedding partnership working was a cultural change. At first it was a challenge for many managers, who were more familiar with the ‘presentation then consultation’ approach.
It is difficult to monitor the outcomes of partnership working when it has been embedded within the organisation’s culture, rather than a causal relationship between partnership working and a particular outcome. For example, it is difficult to measure improvements to service delivery, even though it is likely that the outcome would not have been achieved without the close working relationship between management and staff side. An example of this came with the increased productivity achieved through the performance improvement programme (PIP).
Productivity Improvement Programme
The PCT was selected to be part of a pilot programme called Productivity Improvement Programme (PIP). This involved working with the West Midlands SHA and Ernst & Young to design and develop a toolkit to improve productivity and performance in community services.
The key aims of the PIP for community services were to develop and pilot a methodology that achieved the following:
- rigorous and insightful analysis including benchmarking of workforce productivity of community services
- assesses current levels of productivity and identified areas for improving value for money
- focuses on developing PCT capacity to manage and improve service delivery.
Work began in September 2007 and the pilot was completed in March 2008. For the PCT the project presented a tremendous opportunity to be involved at the developmental stage of a piece of work which was a priority for 2007/08. It was also extremely challenging during the data collection period as there was over 1.5 million pieces of evidence provided from staff as to the possible improvements to working that could be achieved.
The reason why this project was such a success was because of effective way that staff were involved. From very early on in the process, good communication of the project aims and objectives and proactive engagement with staff and union representatives was a priority. This was particularly important for one element of the programme – the Time to Care project.
Time to Care was an exercise designed to collect detailed data of how clinical teams work on a day-to-day basis. To collect the type of detailed data required, it was decided that completing a diary card exercise was the most cost-effective and timely method. The first functional teams to undertake this diary card exercise were the nursing teams including district nurses, specialist nurses and health visitors. These groups were selected as they make up the largest teams of staff and therefore have the most impact on workforce productivity.
There were definite risks associated with undertaking this piece of work as it could have been perceived negatively as a time and motion study. However, this was prevented by:
- having early meetings with union representatives to explain the methodology and the key objectives
- developing a communication briefing for all staff participating in the exercise
- involving managers and senior clinicians in the development of codes to be used in the diary card exercise
- presenting the Time to Care project to the Trust Negotiating Committee.
"This consultative approach was rewarded with excellent staff engagement and high levels of motivation. It led to a healthy level of interest in the project outcomes and key findings. Since the completion of the Time to Care project for nurses/ health visitors, the data and key findings have been presented and shared with the participating clinical staff and posted on the PCTs intranet. The project’s success has provided a catalyst for other staff teams to undertake this exercise and our therapy services completed their own Time to Care in December 2008".
Vic Middlemiss – Provider Services Business Manager
Top tips from Wolverhampton PCT
For successful partnership working:
- there has to be a genuine desire and commitment, initially from the top of both management and staff side
positive leadership is the key
- create a self-assessment of how you see the organisation and what you want to change, include staff interviews and focus groups to compare what the staff feel and what you feel are the priorities
- identify those who are strong believers in partnership working and use them to help convince others
develop joint agendas to work on and share the responsibility and work load
- develop a joint set of values, principles and aims and objectives
- develop a self-assessment tool, to measure progress and evaluate what you have done in the early stages.
and what to avoid:
- do not play at partnership working, otherwise you will lose credibility fast
- do not put things in place you will only use now and again, this has to be part of developing a new culture
- do not become disheartened when it goes wrong, it will at some stage; have a recovery plan and get things back on track.
Further information and contact details