Conexus Healthcare Five-year Strategy 2023-2028

Executive Summary:

Conexus Healthcare CIC is a network of GP practices in Wakefield District committed to providing high-quality, patient-centred care. This strategy outlines our five-year vision and direction, focused on improving care standards and health outcomes for the people of Wakefield.

Our primary goal is to create tangible support that benefits our practices and the local community. We believe our collaborative relationship, offering total geographic coverage of all registered patients in the district, uniquely positions us to achieve this.

To achieve our goal, we will use the Conexus infrastructure to:

Provide a pick-and-mix offer of corporate infrastructure to our GP practices and PCNs, including employment, HR, finance, purchasing, research support, digital support, and professional supervision. Use of these services will grant local GPs access to specialist skills increasing their resilience and efficiency and improving collaboration with larger system partners.
Deliver operational services at a greater scale for increased efficiency, including urgent primary care. By expanding the provision of General Practice to our patients, we will improve access to primary care services particularly outside core GP hours.
Offer a one-stop-shop for General Practice training and consultancy in West Yorkshire and sell our accredited training programs, including care navigation, social prescribing, and medical administration nationally. These courses will generate income for the federation as well as improving the quality and consistency of care for patients accessing General Practice thus directly improving patient outcomes.
Work alongside our LMC, ICB, PCNs and Practices to advocate for General Practice in partnership conversations and planning for Wakefield Health Care Partnership and the West Yorkshire Integrated Care System.
Support our practices to collaborate and share best practice, capitalising on collective intelligence and innovation as well as the shared efficiencies of working together and avoiding duplication.

We believe that by focusing on these key high-level objectives, and building on our pre-existing strong foundations in these areas, our GP federation will be better equipped to address the challenges of a changing healthcare landscape and provide the best possible care to our patients into the future. At the same time, we will not be rigid to this strategy and recognise the need to remain agile in response to changing national directives and local opportunities.
To implement this strategy, we will work with our shareholders to identify annual priorities, and the Conexus Board will oversee the implementation of these developments, using resources flowing from local contracts with the ICB, national sales of our training solutions, practice contributions from the PCN DES, and direct costs for any GP purchased services.

Section One: Company Introduction:

Conexus Healthcare CIC is a Community Interest Company that provides a comprehensive support infrastructure to GP practices in the Wakefield District. Our services include employment, training, HR, and finance, and we offer district-wide services including urgent primary care. With our vast experience in primary care, we offer a nationally recognized training program.

Our Purpose: Our primary objective is to provide tangible support that benefits our practices and the people of Wakefield.

Our Values: At Conexus, we pride ourselves on our people, teams, and culture. We recruit based on our values, which we embed into everything we do. Our values include:

Transparency and honesty
Active listening and collaboration
Delivering great value through quality and innovation
Being proud to grow our business and learn from our mistakes
Sharing our learning generously
Cultivating and developing primary care staff, providers, and leaders.

Our goals: Our goals are in line with our purpose and include:

Providing a pick-and-mix offer of supportive infrastructure to our practices and Primary Care Networks, supporting and strengthening their operations.
Delivering district-wide services under our brand “GP Care Wakefield,” expanding the provision of General Practice to our patients, improving access to primary care services.
Providing a one-stop-shop for General Practice training and consultancy in West Yorkshire and selling our accredited training programs nationally.
Holding district-wide contracts on behalf of General Practice for delivery by our PCNs or practices.
Supporting our practices with the delivery of district-wide services, where the efficiencies or scale dictate the need to deliver it once.
Offering a unified voice for General Practice in the district and advocating for General Practice within the wider community of stakeholders.

By focusing on these goals and building on our existing strong foundations, we believe that our GP federation will be better equipped to address the challenges of a changing healthcare landscape and provide the best possible care to our patients. We will work with our shareholders to identify priorities to grow and implement the strategy on an annual basis. The Conexus Board oversees the implementation of these developments in successive years utilising contractual resources flowing from local contracts with the ICB, national sales of our training solutions and practice contributions from the PCN DES, as well as direct costs for any GP purchased services.

Our Structure

At Conexus, we believe that federated working and collaboration are essential for achieving our mission of improving the quality of care and health outcomes for the people in Wakefield district. Our board reflects this structure by being largely elected from the shareholding practices, with seven GPs, two Practice Managers, and two Practice Nurses. Additionally, we select a Managing Director and two Independent Directors who bring commercial and financial expertise to the board. Our board’s main responsibilities include providing oversight and direction to the company, ensuring that our activities are aligned with our purpose and objectives, and making strategic decisions that benefit our practices and the people of Wakefield.

Our Managing Director is responsible for the day-to-day operations of the company, overseeing the delivery of our services, and implementing the Board’s strategic decisions with the support of the Senior Leadership Team. The independent directors bring a wealth of experience in various areas, such as healthcare management, finance, and business development, and provide valuable insights and guidance to the board. By having a diverse and experienced board, we can ensure that we have the skills and expertise needed to make informed decisions and achieve our objectives.

To strengthen collaboration between our practices, we organize our operations as shown in the accompanying diagram overleaf. Our GP practices elect the leadership of both Conexus and their PCNs, whilst using Conexus infrastructure to allow for efficient use of resources.

To ensure efficient and effective delivery of our services, we have established a Senior Leadership Team that is responsible for the day-to-day management of our company’s activities. Our Senior Leadership Team comprises of experienced professionals who are experts in their respective fields, including:

Managing Director: Our Managing Director provides strategic leadership and oversight of the company, ensuring that we achieve our goals and objectives while maintaining high standards of service delivery.
Deputy Managing Director / Chief Operating Officer: Our Deputy Managing Director / Chief Operating Officer is responsible for the management and oversight of our clinical services, training and consultancy, research, and any services we provide on a district-wide footprint. This role also serves as our Registered Manager.
Clinical Director: Our Clinical Director provides medical leadership and assurance across all areas of the company, ensuring that our services are of the highest clinical quality and that our patients receive the best possible care.
Head of Finance: Our Head of Finance provides financial and contractual planning, management, and assurance across all areas of the company, ensuring that we use our resources efficiently and effectively.
Head of General Practice and PCN support: Our Head of General Practice and PCN support oversees our PCN and Practice support activities, including ARRS roles, workforce planning, digital support, and practice escalation, ensuring that we support our practices effectively.
Head of Corporate Services: Our Head of Corporate Services oversees our HR, communications, governance, and administration functions, in addition to serving as our company secretary.

In addition to our Senior Leadership Team, our services are divided into four core groups, including Clinical Services, Training and Consultancy, PCN and Practice Support, Corporate and Finance, which work collaboratively to deliver high-quality services that meet the needs of our patients and clients.

Our services

Our current range of services is well established and we are committed to maintaining and expanding them in the future. Our services can be grouped into four core areas:

Clinical Services: Our GP Care Wakefield brand provides evening and weekend appointments that are aligned with both Enhanced Care and urgent care contracts. We also offer other clinical services, including clinical research, health checks, and staff banks.
Training and Consultancy: We offer local Resilience Academy and TARGET sessions, as well as national training for Care Navigation, Social Prescribing, and medical administration.
GP and PCN Support: Our support services include employment of the ARRS roles, coordination of PCN inter-working, practice resilience support, and Future Selph programs (which provides mental health services for 16-25-year-olds).
Corporate Services: We provide HR, communications, administration, and governance support services, as well as finance services for our PCNs and internal functions.

Our services are well-established, and we intend to build on this strong foundation in the coming years. We recognize that the next five years will be a journey of evolution, not revolution, as we strive to improve and expand our services to meet the needs of our stakeholders.

Section Two: Our 5-year Objectives.

To achieve our goals, we have planned a comprehensive infrastructure, as shown in the diagram below. This infrastructure will take several years to create with the prioritisation of areas being set annually via the Annual General Meeting.

Our long-term objectives are divided into five key areas:

Back-office support:

We recognise the importance of HR and finance support. We will offer direct employment for PCNs in addition to professional support and advice from HR professionals to both practices and PCNs. We will expand the range of services we offer to include recruitment, employment, Freedom to Speak Up Guardian, workforce planning, and Organisational Development. We will also provide our HR protocols and policies to shareholders via a shared portal and support our practices with practical advice such as applying for visa sponsorship.

In addition, we will offer finance support to GP practices from our finance team, including budgeting and analysis of income/expenditure, support with claims and payroll services. For PCNs we will also offer nominated payee status.

We will also provide GP resilience support by embedding escalation processes to help struggling practices access advice and support.

Strategic development:

We will develop support for practices and PCNs in writing and implementing strategies, plans, and business cases. This will include access to specialist input around areas such as estates, digital, and workforce.

We will expand our communications and engagement team to offer practices and PCNs access to patient, staff, and practice communications and engagement including PPGs, social media, and updates.

Additionally, we will aim to establish a commercial PMO to support practices with the practical implementation of ideas that currently don’t get embedded due to a lack of capacity.

Training:

We will continue the Wakefield Resilience Academy and expand its customer base to West Yorkshire. We will also develop and sell nationally our courses including Care Navigation, Social Prescribing, and Medical Administration.

In addition, we will develop a professional supervision offer for General Practice to support with development of both ARRS roles and core GP roles.

We will further develop our courses and mentoring to promote future Primary Care leaders in the district.

Operational support:

We will continue to deliver the Enhanced Access and Urgent Care contracts via GP Care Wakefield. Additionally, we will explore ways to support GP urgent care demand through initiatives such as Paediatric Observation Units and Acute Respiratory Infection hubs.

We will expand our research support offer to practices and expand to include evaluation locally.

We will also explore the feasibility of workflow hubs, predicated on the centralisation of clinical administration into PCN-level hubs for functions such as letter-coding and summarising.

Finally, we will continue to refine our staffing bank, including non-clinical roles as well as remote working, and support the vaccine staff bank.

Collaboration and partnership:

We will work closely with the LMC, ICB, PCNs and GP practices to provide a unified voice for General Practice in the district and advocate for General Practice within the wider community of stakeholders.

We will provide feedback from partnership meetings and a chance to escalate problems.

We will also establish a Practice Manager Steering Group and a Practice Nurse Forum with an aim of amplifying their voice within the system and ensuring that Conexus is steered according to the changing priorities of General Practice.

We will provide a shared portal for sharing best practice and coordinate collaboration between practices, PCNs and neighbourhoods.

Section Three: Our Priorities for New Developments

In addition to delivering and refining our existing services, we will prioritise new developments on an annual basis using a business cycle centred around our financial year end. We will involve our stakeholders in this process through our forums for Practice Managers, Business Managers, Practice Nurses, and General Practitioners, where we will identify potential priorities from our strategy or other emerging needs. Shareholders will then vote for their priorities in advance of our Annual General Meeting (AGM). At the AGM, shareholders will be asked to approve the priorities and business plan for the coming year, and we will present a report on progress against the previous year’s priorities.

We will establish this process fully for prioritisation in advance of the 2024/25 financial year. However, for the 2023/24 financial year, we have identified our priorities through consultation around this strategy, which our board has already approved.

Our priorities for 2023/24 are as follows:

Mobilise a district-wide service to support our practices and PCNs with the use of digital technology. We will pool the ARRS funding for digital and transformation leads in PCNs to employ a skill-mix within the team. This will support our practices in getting the most out of their existing IT, produce a digital roadmap for future developments, promote efficiencies with practices, and support patients to access our digital services. We aim to start recruitment for this service from May 2023 and make it fully operational within the calendar year.
Support our PCNs with the recruitment and training of GP Assistants. We will also provide recruitment and training for GP reception staff to minimise any disruption should any of our reception staff wish to progress into the new role. In addition, we will explore the mobilisation of workflow hubs to support amalgamated approaches to document management, coding, and summarising.
Employ a Primary Care Workforce lead who will be responsible for supporting PCNs in maximising their in-year ARRS expenditure with workforce planning. The lead will implement initiatives to promote the retention of GPs, Practice Nurses, and Practice Managers within the district. They will also develop a tiered professional supervision offer for PCNs and practices, ensure that our practices are linked into all available funds and opportunities relating to our workforce, support practices in their visa sponsorship applications, and work with the Health Care Partnership to include General Practice in International Recruitment initiatives.
Establish a Practice Manager Steering Group for Conexus that will amplify the voice of Practice Managers and ensure that Conexus remains closely aligned with current issues. We will also use this forum to promote federated working amongst practices and reduce duplication of workload where possible.
Improve our communications and engagement with practices by developing a clear communications plan centred around our GP audience.
Develop an HR support offer for GP practices, expanding the service we currently offer to PCNs. This will allow us to offer specialist advice and guidance from HR advisors on a subscription basis in addition to HR policies and protocols.

We will also intentionally explore and plan for future delivery of the following:

A shared repository of protocols, training materials, and shared best practice. This may be an intranet or a SharePoint drive, depending on the planning. The intention is to create a space for current, updated resources to avoid practice duplication.
Options for bulk purchase and procurement with the intent of reducing costs for practices.
A proportionate expansion to our research support offer focusing on increasing the district’s research activity in primary care. We will also explore less formal research, including evaluation and quality improvement.
Conduct explorative research into the expansion of our urgent primary care offer via GPCW, principally looking at the potential for paediatric observation units, recurrently commissioned Acute Respiratory Infection Hub, and same-day urgent PCN hubs.
Expand our training offer, linking our course development to arising practice need.

Section Four: Our Financial Planning and Assumptions

Over the past few years, we have experienced significant growth and plan to continue expanding our range of services according to our strategy. As our range of services expands, so does the required corporate infrastructure, which is funded by three core sources: contractual delivery for Wakefield ICB, contractual delivery for PCNs / practices, and national training sales/other projects. However, we currently have several short-term contracts that pose a risk to our longer-term financial sustainability.

To address this, we need to improve the length of our contracts and produce multi-year budgeting and plans. As part of our planning, we have made the intentional decision not to diversify away from our core services, as this may create a distraction from our primary purpose. We also do not intend to deliver services outside the Wakefield District, except for training.

To minimise costs and ensure that our pricing for local services is consistent and transparent, we have established a Cost Sharing Group for services delivered on behalf of our practices and PCNs. This includes direct overhead costs but will not generate surplus. We do aim to generate a surplus on national training sales, which will be reinvested locally to fund further growth and development of our services. The Cost Sharing Group will also ensure that our services do not require VAT to be charged to our practices or PCNs.

To mitigate financial risk in future years, we will build a financial reserve for the company. This will be built over successive years, with the aim of eventually retaining a total reserve representing 5-10% of annual turnover. This will give us resilience against unforeseen risks and allow us to weather storms.

Finally, we are committed to being transparent with our shareholders and stakeholders. We will share our financial plans and assumptions annually at our AGM, alongside our annual accounts for the previous year. By doing so, we aim to demonstrate our commitment to financial transparency and sustainability and to building a strong, resilient company that can continue to provide high-quality services to our shareholders.

Section Five: Our Stakeholder relationships

At Conexus, we recognise the importance of maintaining strong relationships with our stakeholders to ensure the success of our organisation and the delivery of quality services to our community. We prioritise our community of interest and focus our services and support accordingly, adapting to changes in national directives and ensuring our practices are in line with our strategic vision.

General Practices: Our Board comprises of strong GP, Practice Manager, and Practice Nurse representation, giving our shareholders a majority decision-making processes for the company. We aim to increase our connection with practices by establishing a Practice Manager steering group, in addition to regular Practice Manager meetings. Additionally, we will enhance our GP engagement, improve our communication channels, and identify and address practice needs to ensure our shareholders’ voices are heard and valued.

Primary Care Networks: Our PCNs are an essential part of our network, and we work closely with them through various forums, including Network Thursday, the Business Managers’ Meeting, and the Enhanced Access Board. Our direct delivery of services, such as the Additional Roles Reimbursement Scheme (ARRS) employment, requires regular meetings with our PCNs to oversee delivery and ensure alignment with their priorities.

Local Medical Committee: We value our collaborative relationship with Wakefield LMC, which represents individual GPs in the district, and meet regularly with them and the ICB Primary Care team to align our initiatives. Their support in the development of our strategy is invaluable, and we will continue to work closely with them to ensure alignment with practice priorities.

ICB Primary Care Team: Our Primary Care team in Wakefield ICB is a crucial stakeholder, and we hold a supportive and collaborative relationship. We hold regular meetings to discuss new developments, maximise available resources, and agree on the strategic direction and support of primary care in the district.

Wakefield Health Care Partnership: The Wakefield Health Care Partnership, composed of all major local delivery partners, including our Foundation Trusts, Local Authority, commissioners, and voluntary sector colleagues, is an important strategic collaboration for our practices. We attend partnership committees, provider collaboratives, and alliances, along with the LMC and ICB, to explore integrated working possibilities between providers.

West Yorkshire ICS: Whilst much of the decision-making and delivery of the Integrated Care System has been delegated to place, we continue conversations with the West Yorkshire CD Reference Group, Primary Care Workforce Steering Group, and Primary Care leadership colleagues to ensure shared efficiency and planning. We are also building links with the newly-formed Fuller Board, which we feel will be instrumental to the area’s direction and opportunities moving forward.

West Yorkshire Federations: We value the peer support and joint working opportunities with our sister federations across West Yorkshire and meet regularly with several of them. We aim to establish frequent meetings with all places to support each other and highlight collective issues to the West Yorkshire ICS.

National Federations: Finally, we have strong links with national federations and work collaboratively with them for sharing best practices and opportunities arising nationally.

Section Six: Summary

In summary, our strategy outlines an ambitious vision for the future of Conexus, which is focused on strengthening our relationships with our stakeholders and serving our Community of Interest with a renewed emphasis on General Practice support. Over the next five years, we will expand our range of practical support services to our shareholders and seek out new contracts to support urgent primary care needs across the district.

To achieve these goals, we have identified clear objectives and priorities for the next 12 months, and we have established a process for setting annual objectives going forward. We are committed to transparently reporting our progress against these priorities, and we will adjust our approach as needed to ensure that we are effectively meeting the needs of our stakeholders.

One of our key priorities is to enhance our engagement with local practices, by improving our communication channels and identifying and addressing the specific needs of our shareholders. We recognise that our shareholders’ voices are essential to the success of our organisation, and we are committed to ensuring that they are heard and valued throughout the process of developing and implementing our strategy.

Ultimately, we believe that this strategy will support our core purpose and contribute to improving patient outcomes and increasing practice resilience across the district. By working closely with our stakeholders and prioritising General Practice support, we are confident that we can achieve our goals and create a more sustainable and effective healthcare system for everyone in our Community of Interest.