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Practice merger case study: Trinity Medical Centre, West Yorkshire

Trinity Medical Centre in Wakefield, West Yorkshire is the result of a merger between Almshouse Surgery & Grove Surgery in April 2017. Dr Omar Alisha, a GP partner at the practice says the spur for the merger was shared vision.

The two surgeries had already been working out of the same premises and sharing a nurse-led telephone triage system for patient appointments, he explains. But they were keen to forge a closer relationship in order to improve patient care.

‘We could see the benefits of working at scale such as being able to share workload and offer more services. The two practices also got along so it made sense,’ Dr Alisha says.

The practice now covers 24,000 patients, has 10 GP partners, five salaried GPs and a nursing team involving four advanced nurse practitioners, six practice  nurses and six healthcare assistants.

Keeping staff and patients informed

Dr Alisha, admits the challenges around the merger were steep. First and foremost, he explains, was tackling the people issues in order to allay any anxieties or concerns.

‘We informed staff as soon the decision was made in February 2016, so there was no time for the rumour mill to start,’ says Dr Alisha. ‘We explained the reasons for the merger and set out its benefits, assuring them that nobody was being made redundant.

‘We were also keen to involve patients in our plans as soon as we made the decision public. This early and full involvement meant we headed off major problems, I think.’

The practices merged their patient representative groups ahead of the merger and this group met regularly to discuss the development of the merger and provide patient feedback to the practices.

The practices also had a two-month engagement period during July and August 2016. During this time they produced publications about the merger, had members of the patient representative group available in the waiting room to discuss the merger with patients and arranged an open evening to allow patients to speak to staff about the merger, which they publicised on social media, by text and email and in all letters sent to patients.

There are examples of the communications the practice produced on its website here.

What has also helped, he says, is appointing someone to a newly created ‘customer service’ role. ‘Really, this person is there to sort out any issues patients are not happy about,’ Dr Alisha says. ‘It’s a sort of PR role. It gives us a better understanding of where we need to improve and ensures the patient is happy with their care.’

Partnership agreement

Negotiating the partnership agreement was trickier. ‘We had different sick leave, holiday entitlement and so forth, so we had to review everything. We had to reach compromise between 10 or so GP partners but we did it by allowing ourselves enough time to work it through. It’s a process.’

A merger can also require practices to rethink the way they operate. Trinity now holds a weekly operational meeting to ensure the smooth running of the practice. ‘Running a large practice is very different,’ Dr Alisha explains. ‘We have to regularly go through everything from prescriptions to appointments to ensure nothing is missed.’

Benefits of the merger

But Dr Alisha believes the merger has been a positive step. Patients now have access to a wider set of specialist services because the skill mix from the two teams is bigger. So, for example, they are able to offer a minor surgery clinic and MSK expertise to all of the patients.

The triage centre that was already in place has also now been extended to cover the entire CCG patient population during out of hours.

The practice has also seen an improvement in recruitment and four salaried doctors have joined the team since the period just before the merger.

Medeconomics Guide to Practice Mergers

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