Accelerating primary care transformation. Commissioning Live, Birmingham 2015
30
www.england.nhs.uk @robertvarnam Accelerating primary care transformati on Dr Robert Varnam Head of general practice development [email protected]@robertvarnam Commissioning Live, Birmingham 30 June 2015 bit.ly/ 20150630transform
Accelerating primary care transformation. Commissioning Live, Birmingham 2015
1. www.england.nhs.uk @robertvarnam Accelerating primary care
transformation Dr Robert Varnam Head of general practice
development [email protected] @robertvarnam Commissioning Live,
Birmingham 30 June 2015 bit.ly/20150630transform
2. @robertvarnam #PMChallengeFund Myth 4: Our good ideas are
all we need When youve been working on a set of ideas for what
changes to make to your service, its natural to become quite
attached to them. You may have had some feelings of resentment
lately as people have asked you probing questions about them,
through the due diligence process. The trouble is, the consistent
experience of people leading large scale change is that 70% of
efforts fail. Not just in the NHS, or in healthcare, but worldwide
in every industry. And one of the big factors causing that
depressing experience is a belief that good ideas are enough.
Theyre not. Theyre obviously necessary, but Im afraid theyre not
sufficient. Along with the WHAT of your change, you need the HOW.
The strategies, tactics and methodologies by which you turn the
good idea into a movement of people and a plan of action. If you
dont skilfully lead people, if you dont use an effective
improvement methodology, if you dont measure right the evidence
shows you risk failing. Well do all we can this year to support you
with the HOW of change. Id ask you to start by commiting to have
plans which combine the how and the what, and which unleash your
practices commitment by clearly articulating the WHY (well talk
more about that later) WHAT HOWWHY @robertvarnam
3. @robertvarnam #PMChallengeFund Myth 4: Our good ideas are
all we need When youve been working on a set of ideas for what
changes to make to your service, its natural to become quite
attached to them. You may have had some feelings of resentment
lately as people have asked you probing questions about them,
through the due diligence process. The trouble is, the consistent
experience of people leading large scale change is that 70% of
efforts fail. Not just in the NHS, or in healthcare, but worldwide
in every industry. And one of the big factors causing that
depressing experience is a belief that good ideas are enough.
Theyre not. Theyre obviously necessary, but Im afraid theyre not
sufficient. Along with the WHAT of your change, you need the HOW.
The strategies, tactics and methodologies by which you turn the
good idea into a movement of people and a plan of action. If you
dont skilfully lead people, if you dont use an effective
improvement methodology, if you dont measure right the evidence
shows you risk failing. Well do all we can this year to support you
with the HOW of change. Id ask you to start by commiting to have
plans which combine the how and the what, and which unleash your
practices commitment by clearly articulating the WHY (well talk
more about that later) WHAT HOWWHY What change is needed in primary
care? @robertvarnam
4. www.england.nhs.uk @robertvarnam The founding principles of
UK primary care are admired the world over, and rightly so. General
practice is a jewel in the crown of this country. Right now,
general practice feels in a bad place. Constrained, hemmed-in and,
to some, marginalised. Whatever the state of things in your part of
the country, in general, I think its fair to say that, at the very
least, general practice is currently constrained from delivering
its full potential. We need to see increases in funding, a growth
in the workforce, and improvements to premises. Without those,
existing services may not be sustainable. Pressure
5. www.england.nhs.uk @robertvarnam Pressure Scottish School of
Primary Care
6. Health & wellbeing-promoting care Right access
Consistently high quality Holistic, personalised, proactive,
coordinated care
7. Phone first. Community diagnostics. Practice based
paramedics. Pharmacy first. Web consultations. Primary care led
urgent care centre. Minor injury service. Physio first
8. Direct specialist advice. Condition management training.
Shared records. Care coordination. Hospital in-reach. Care home
ward rounds. Virtual ward. Primary care-employed specialists.
9. Social prescribing. Travelling health pods. Peer-led walking
groups Health coaching. Befrienders. Schools outreach. Community
development.
10. www.england.nhs.uk @robertvarnam So why are people talking
about change? Its partly about the pressure were under right now,
and partly about the huge opportunity to do something better. And,
for once, the same changes that would help with one are also
necessary for the other. Pressure Opportunity
11. Its too easy to approach challenges just by thinking we
need more. The NHS has a well established habit of this new
initiatives, new challenges or opportunities are usually met by us
talking about more. More money, more staff or both. And, we know
that, in general practice, we do need both more money and more
staff. BUT and its a big but just doing more of the same is simply
not going to cut it any longer. Not just more of the same
12. www.england.nhs.uk @robertvarnam bit.ly/nhs5yfv New types
of organisation Multispecialty Community Providers Primary and
Acute Care Systems
13. www.england.nhs.uk @robertvarnam Multispeciality Community
Providers GP practice GP practice GP practice GP practice GP
practice GP practice GP practice GP practice Specialists
Pharmacists Community provider SC provider VCS VCS VCS MH Trust VCS
VCS VCS
14. www.england.nhs.uk @robertvarnam Primary and Acute Care
Systems Community provider SC provider VCSMH Trust Acute provider
GP practice GP practice GP practice GP practice GP practice GP
practice GP practice GP practice
15. @robertvarnam #PMChallengeFund Myth 4: Our good ideas are
all we need When youve been working on a set of ideas for what
changes to make to your service, its natural to become quite
attached to them. You may have had some feelings of resentment
lately as people have asked you probing questions about them,
through the due diligence process. The trouble is, the consistent
experience of people leading large scale change is that 70% of
efforts fail. Not just in the NHS, or in healthcare, but worldwide
in every industry. And one of the big factors causing that
depressing experience is a belief that good ideas are enough.
Theyre not. Theyre obviously necessary, but Im afraid theyre not
sufficient. Along with the WHAT of your change, you need the HOW.
The strategies, tactics and methodologies by which you turn the
good idea into a movement of people and a plan of action. If you
dont skilfully lead people, if you dont use an effective
improvement methodology, if you dont measure right the evidence
shows you risk failing. Well do all we can this year to support you
with the HOW of change. Id ask you to start by commiting to have
plans which combine the how and the what, and which unleash your
practices commitment by clearly articulating the WHY (well talk
more about that later) WHAT HOWWHY What capabilities will primary
care need? @robertvarnam
16. www.england.nhs.uk @robertvarnam Strong network /
federation facilitates service development Not all
networks/federations/superpractices are equal GPs dont always like
being led, but leadership is key Experience of PM Challenge Fund
Huge variety in legal forms, structure, etc no evidence about
superiority for delivering change programme / improved care (but
?other factors, eg economies of scale) Size may matter
17. www.england.nhs.uk @robertvarnam Size may matter Category
Average time for full mobilisation % of practices offering weekday
extended hours provision as a result of PMCF (at full mobilisation)
% of practices offering weekend extended hours provision as a
result of PMCF (at full mobilisation) Scope Leadership Small (50) N
= 4 8 months 55% 66% More likely integrated with system- wide
transformation Change slower & harder
18. www.england.nhs.uk @robertvarnam Purpose > function >
formPurpose > function > formPurpose > function > form
Experience of PM Challenge Fund Purpose > function > form a)
Pick something to improve for patients b) Improve it together c)
Build infrastructure to enable, accelerate & sustain
19. www.england.nhs.uk @robertvarnam Highly engaged culture
Accessible innovations Funding for the work of service redesign
Leadership development QI capabilities Metrics and analytics
capabilities / services Workforce development Enablers of service
redesign PMCF has demonstrated that much can be done with modest
investment and careful choice of approach (most of this is very new
to general practice)
20. www.england.nhs.uk @robertvarnam Innovation support
programme Peer-to-peer exchange Networking events Connect &
share webinars Online discussion forum Evaluation programme
Measurement for improvement Lessons about success National impact
assessment National innovation support team Policy advice &
advocacy Strategy & innovation support Contractual &
performance monitoring Change leadership & service redesign
support Action learning Staff training & coaching Development
advisor PGP-lite This has been the best thing to happen in general
practice for years we've got much more done with a lot fewer bumps
in the road because of the support we've had" We've really moved up
a notch in the professionalism of our leadership approach really
changed our thinking our abilities are now much better matched to
our ambitions I had no idea this stuff [leadership & QI] could
work in general practice Staff are now coming up with their own
ideas for improving services and wanting to have a go
21. @robertvarnam #PMChallengeFund Myth 4: Our good ideas are
all we need When youve been working on a set of ideas for what
changes to make to your service, its natural to become quite
attached to them. You may have had some feelings of resentment
lately as people have asked you probing questions about them,
through the due diligence process. The trouble is, the consistent
experience of people leading large scale change is that 70% of
efforts fail. Not just in the NHS, or in healthcare, but worldwide
in every industry. And one of the big factors causing that
depressing experience is a belief that good ideas are enough.
Theyre not. Theyre obviously necessary, but Im afraid theyre not
sufficient. Along with the WHAT of your change, you need the HOW.
The strategies, tactics and methodologies by which you turn the
good idea into a movement of people and a plan of action. If you
dont skilfully lead people, if you dont use an effective
improvement methodology, if you dont measure right the evidence
shows you risk failing. Well do all we can this year to support you
with the HOW of change. Id ask you to start by commiting to have
plans which combine the how and the what, and which unleash your
practices commitment by clearly articulating the WHY (well talk
more about that later) WHAT HOWWHY What can CCGs do to accelerate
progress? @robertvarnam
22. www.england.nhs.uk @robertvarnam Invest in leadership
development Build Q.I. & B.I. capabilities Commission the
future from GP What could CCGs do? Shape demand Commission better
wrap-around services Develop metrics Build patient
partnerships
23. www.england.nhs.uk @robertvarnam
24. www.england.nhs.uk @robertvarnam Reduce bureaucracy payment
& reconciliation contracts management information flows Reduce
demand increase self help & self management reliable hospital
appointment systems standard local approach to sick notes, etc Work
differently active front end online/phone consultations proactive,
coordinated care + continuity + longer appts enhanced clerical
roles physician associate care navigator Wider primary care at
scale pharmacists physio minor illness nurses social prescribing
welfare rights
25. www.england.nhs.uk @robertvarnam Reduce bureaucracy payment
& reconciliation contracts management information flows Reduce
demand increase self help & self management reliable hospital
appointment systems standard local approach to sick notes, etc Work
differently active front end online/phone consultations proactive,
coordinated care + continuity + longer appts enhanced clerical
roles physician associate care navigator Wider primary care at
scale pharmacists physio minor illness nurses social prescribing
welfare rights
26. www.england.nhs.uk @robertvarnam Reduce bureaucracy payment
& reconciliation contracts management information flows Reduce
demand increase self help & self management reliable hospital
appointment systems standard local approach to sick notes, etc Work
differently active front end online/phone consultations proactive,
coordinated care + continuity + longer appts enhanced clerical
roles physician associate care navigator Wider primary care at
scale pharmacists physio minor illness nurses social prescribing
welfare rights
27. www.england.nhs.uk @robertvarnam Reduce bureaucracy payment
& reconciliation contracts management information flows Reduce
demand increase self help & self management reliable hospital
appointment systems standard local approach to sick notes, etc Work
differently active front end online/phone consultations proactive,
coordinated care + continuity + longer appts enhanced clerical
roles physician associate care navigator Wider primary care at
scale pharmacists physio minor illness nurses social prescribing
welfare rights
28. www.england.nhs.uk @robertvarnam Reduce bureaucracy payment
& reconciliation contracts management information flows Reduce
demand increase self help & self management reliable hospital
appointment systems standard local approach to sick notes, etc Work
differently active front end online/phone consultations proactive,
coordinated care + continuity + longer appts enhanced clerical
roles physician associate care navigator Wider primary care at
scale pharmacists physio minor illness nurses social prescribing
welfare rights
29. @robertvarnam #PMChallengeFund Myth 4: Our good ideas are
all we need When youve been working on a set of ideas for what
changes to make to your service, its natural to become quite
attached to them. You may have had some feelings of resentment
lately as people have asked you probing questions about them,
through the due diligence process. The trouble is, the consistent
experience of people leading large scale change is that 70% of
efforts fail. Not just in the NHS, or in healthcare, but worldwide
in every industry. And one of the big factors causing that
depressing experience is a belief that good ideas are enough.
Theyre not. Theyre obviously necessary, but Im afraid theyre not
sufficient. Along with the WHAT of your change, you need the HOW.
The strategies, tactics and methodologies by which you turn the
good idea into a movement of people and a plan of action. If you
dont skilfully lead people, if you dont use an effective
improvement methodology, if you dont measure right the evidence
shows you risk failing. Well do all we can this year to support you
with the HOW of change. Id ask you to start by commiting to have
plans which combine the how and the what, and which unleash your
practices commitment by clearly articulating the WHY (well talk
more about that later) WHAT HOWWHY @robertvarnam
bit.ly/20150630transform