Standardising and centralising shared functions to improve resilience

Symphony Healthcare Services (Symphony Healthcare) is a wholly owned subsidiary of Somerset NHS Foundation Trust, providing NHS services through the management of 17 practices over 22 locations, predominantly in Somerset. It supports the care of approximately 134,000 patients and contributes to the work of 10 primary care networks (PCNs), one of which solely consists of Symphony Healthcare surgeries. It uses its expertise from working at scale to work closely with other PCNs, other large scale primary care bodies and trusts to learn and share best practice.

General practice has faced increased demand in recent years. This has led to heavier workloads alongside financial constraints due to insufficient funding, exacerbated by workforce pressures, particularly relating to recruitment and retention. To combat these pressures, Symphony Healthcare has developed a model to support its sites in having greater resilience and sustainability for the future. Working at scale has allowed Symphony Healthcare to cut operational costs by standardising and centralising shared functions.

The model focuses on skills and expertise and has involved the centralisation and standardisation of several key functions. These include:

  • Human resources: Functions such as payroll, recruitment, employee relations and training and development.
  • An in-house locum agency: This doubled the number of available bank staff in less than a year.
  • Finances and facilities management: With a dedicated finance team and an automated invoice payment/approval system.
  • Procurement: For example, procurement of energy and consumables to leverage scale and drive cost effectiveness.
  • Data performance: Safety and performance scorecards, that are easily accessible to manage performance and maximise financial returns from funding streams such as the quality outcomes framework.
  • Digital innovations: For instance, a standardised cloud-based telephony platform.
  • Document management: 80% of clinical administration managed through a central hub, freeing up time for GPs (approximately four hours per day per practice, equating to an extra 4,000 appointments annually across the organisation). 
  • Preparedness for Care Quality Commission inspections: A dedicated team to prepare practices for inspections and support standardisation of high-quality care and processes across all the practices. Upon acquisition by Symphony Healthcare, most practices were rated as requiring improvement or inadequate but are now all rated good, with one rated outstanding.
  • Training and Education: To support development at undergraduate and postgraduate level. In addition to GPs, student training is provided to nurses, paramedics and other clinicians. Symphony Healthcare aims for all its practices to become training practices.

Overall, the organisation has realised an estimated £500,000 in savings by centralising these key back office functions while improving processes and support to practices.

Symphony Healthcare's standardisation and centralisation of key shared functions demonstrate the opportunities of at scale working to improve resilience in primary care settings, particularly in the face of growing pressures.