I first went to Lansdowne Surgery around 2018 for a social prescribing workshop; I was struck by the atmosphere in the practice and the light in the modern building and I have to confess to feeling this might be the type of practice that could tempt me back to into practice management.

A year or so later an advert caught my eye, a partnership in Ely with values of fairness and practices based on evidence within a cluster at the beginning of a compassionate communities informed transformation project were looking for a new PM. On visiting I got ‘the feel’ and so my journey back to practice management began and Westway albeit in a building that had seen better days!!

Pre-covid Cluster meetings took me back to Lansdowne Surgery and close working via the transformation project group and it became apparent to me that our two organisations were closely aligned. Acutely aware of the direction of traffic towards larger practices, could Westway and Lansdowne Surgeries be well matched for a merger I pondered.

Covid struck and such lofty musings were pushed aside as we were thrust into fast paced firefighting.

Coming up for air in 2021 having worked closely together through the delivery of covid vaccinations via our drive through clinic our working relationships had matured and trust grown. Thoughts returned to plans for the future, service development and practice sustainability, all that was needed now was a candid discussion over a few gins at an RCGP conference and we were well on our way…..

Spring 2022 and we started preparing with initial planning meetings scoping the project and agreeing a time line. Feeling somewhat smug about the long lead in I can now say that you cannot start planning too soon. The demands of running a practice is all consuming, add the additional work of a merger and it can feel overwhelming. Establish a project team to drive and monitor progress. I had learnt from experience that time and effort could be wasted if there wasn’t financial transparency early on; I had previously seen planned mergers grind to a halt wasting months of effort when it becomes apparent that the two partnerships are not financially compatible. We therefore signed up to a ‘Memorandum of Understanding’ and had a joint meeting with our accountants. Once it was clear that we were financially matched we committed to the merger and began the process of stakeholder engagement.

We presented our proposal to the staff in December 2022 sharing the rationale for the merger and the expected opportunities for staff. Unified leadership from the Partners is essential to reassure staff and convey stability; any chinks in appearance could result in suspicions of takeover rather than a mutually agreed and equal merger. From experience I know if Partners are not on board a sense of being ‘done to’ can emerge instigating resistance and mistrust.   

Public engagement with the support of Llais took the form of open public meetings and Comms via posters in local pharmacies, partner agencies, social media and websites. Our Comms strategy was sound but our execution could have been better. It tended to be the area that would be neglected in times of pressure resulting in angry and misinformed patients. Ensuring accessible Comms from the start saves time in the long run spent fielding queries and concerns. Our post merger comms also suffered from time constraints with support available from the UHB we really missed this opportunity to communicate better with stakeholders about our operational systems and strategic plans.  

Following stakeholder engagement and staff consultation we then spent the summer in working groups reviewing our processes to agree new protocols. Feeling confident and ready with all the legals and IT transfers in place we accelerated towards our merger D Day   of the 1^st October 2023.

It was eerily calm on merger day; we couldn’t quite believe our luck. Using our system ‘downtime’ we utilised Vision 360 and delivered our flu vaccine clinics from both sites; we were fully operational after a day and a half. However, it gradually became apparent that all was not well…..

No access to WCCG for days, scanners not working, label trace malfunctions and the inability to log in to Docman all dragged on from days to weeks. Staff discontentment brewed, IT issues coupled with miscommunications about joint processes quickly brought any honeymoon period to an end. First thoughts of ‘what have we done?’ started to bubble away beneath the surface.

DHCW were a great support and on reflection these issues can be filed away in the ‘teething troubles’ folder but at the time stress levels were high and the staff were unhappy; I felt I was loosing good will and good faith.

A challenging few months followed, it was almost a bereavement process where staff were at times in ‘denial’ ( a sense of if we shout loud enough it might go back to how it was pre-merger), there was certainly ‘anger’ and a lot of ‘bargaining’.  Five months in and we appear to be in the ‘acceptance’ phase where things feel more settled and positive.

In terms of team development I feel we have entered the ‘norming’ phase; personnel working across both sites and professional teams aligning. As we emerge from one of the hardest winters ever for  general practice I feel proud the Afon Elai Partnership is well on it’s way to ‘performing’ for staff and patients and with a secure future. With Partner retirements on the horizon we have attracted interest from excellent candidates to join the partnership; something I am confident is a result of establishing a new, forward looking, larger and future proofed practice. 

So on reflection my main points of learning to share:

• It’s never too early to start to prepare
• Don’t pretend things won’t be different post merger
• Prioritise communications; external and in house. Involve patients in a steering group
• Don’t underestimate how long it takes to agree a Partnership Deed
• Partners should lead from the front
• Involve staff in working groups and process decisions.
• Due diligence – pay particular attention to premises ownership, leases and individual partner credit rating
• Instigate new practice meetings from day one
• Integrate staff across sites
• Timing – choose the spring to merge. Merging then going into winter pressures was not our best decision!
• There is lots of support available….use it!

And personally I reflect that it was meant to be, when I work from Lansdowne site I reminisce about my first visit there and can’t quite believe that I have ended up working there in a new merged entity with Westway, the partnership whose values brought me back to practice management.