The Brains behind the Foundry

Any doctor who chooses to work in a remote Australian outback hospital, has to be someone special. Someone who embraces change and a challenge. ‘A steep learning curve.’ is how Dr Phil Wallek, described his experience. Now a Partner at School Hill GP Practice he is a man of many talents, with a vision and a mission - his passionate belief that community patient services can and should be improved. His ideas about how this could work have clearly been influenced by his diverse background in medicine, from surgery to A&E, and that stint in the Australian outback. Eventually choosing general practice, persuaded by his GP wife, he studied further, achieving a diploma in dermatology, because as he wryly commented, ‘If you’re cutting things off you need to know what they are before you cut them off.’ As a specialist GP, the experience he gained by setting up a community dermatology team in Brighton, led him to taking on managerial roles and studying leadership at his Practice. This sparked his interest in adopting a strategic approach, initially in dermatology, and then the realisation that it could be applied to general practice.

With his colleagues at School Hill he began improvements at the Practice, by introducing new systems and looking at different ways of working, improving quality, whilst at the same time moving on and looking outside for examples of where best care was being delivered. He came across the concept of ‘Federation’ in which Practices join together as one organisation with shared objectives to improve care, but at the same time each Practice maintains a degree of independence. Looking around nationally he found examples of where this was working well, in London, Birmingham and Manchester.

Although the initial idea was for all GP Practices within the Clinical Commissioning Group (CCG) to participate many decided they were not ready for this move, so as Dr Wallek says ‘we had to pick ourselves up and decide what would work.’ A decision was made to focus on just the three Lewes GP Practices to federate, as change was needed by pressure from the Government for provision of a 7 day/week service and the increasing difficulties recently in recruiting doctors to general practice. School Hill Practice had already been in negotiations with the council to have a bespoke surgery on the proposed Phoenix Development, as their current accommodation is not fit for purpose. With St Andrews’s Practice in a similar situation, an approach was made to both them and River Lodge Practice, with federation as a possible way forward and this included a plan for a much larger building on the Phoenix to accommodate all three Practices and other community services.

Over a period of 3 years this process has taken a great deal of time, goodwill, consultation, resilience and persuasion with involvement of all staff. There have been many drawbacks on the way, but as Dr Wallek explained, ‘You dust yourself down and start again.’ Out of this, a new and exciting concept of delivering healthcare to the community has been drawn up and although it is still evolving, last year it was at a stage where it could be shared with patients. He enthused, ‘we are an entity so doors are opening Nationally, so we can celebrate what we are doing and showing enough people that this is the way things need to happen, which is great news for attracting funding, and it adds a great deal of credibility to what we are doing.’

‘Our registrars from the medical school are amazed at what we do as GPs and hopefully their experiences with us will encourage them to enter general practice, which has traditionally,’ and in his opinion erroneously, ‘been regarded as the ‘poor relation’ of medicine.’ He admitted to feeling somewhat aggrieved when asked on more than one occasion, ‘what he was going to do next!’

When asked about costs he said, ‘We need to get across this is not about a costing saving exercise, that it’s going to be cheaper. No it’s going to be more expensive - it about going forward not back and not saying we’re closing the doors to services and saying that’s it, we can’t do any more - no we’re not doing that - we want to be the service that does things.’

‘Funding is very difficult. It’s challenging with the NHS and of course, as Practices we are our own businesses with our own funding and we’ve bought into this plan. So when you’re asking someone to sign up for this as Partners, they are risking their own income, their own house, their life. As Partners we’re not only investing the NHS’ money we’re investing and risking ourselves as well.’

Dr Wallek eloquently summed up what has been, and continues to be his vision, ‘We have decided to step up from what our traditional role is and be an organisation that is bigger, whilst holding on to the values and the culture of all the good things that are the backbone of general practice. It’s the Patients Journey the Patient’s Story which is what is driving us.’