1. 1. www.england.nhs.uk @robertvarnam Accelerating primary care transformation Dr Robert Varnam Head of general practice development robert.varnam@nhs.net @robertvarnam Commissioning Live, Birmingham 30 June 2015 bit.ly/20150630transform
2. 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. 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. 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. 5. www.england.nhs.uk @robertvarnam Pressure Scottish School of Primary Care
6. 6. Health & wellbeing-promoting care Right access Consistently high quality Holistic, personalised, proactive, coordinated care
7. 7. Phone first. Community diagnostics. Practice based paramedics. Pharmacy first. Web consultations. Primary care led urgent care centre. Minor injury service. Physio first
8. 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. 9. Social prescribing. Travelling health pods. Peer-led walking groups Health coaching. Befrienders. Schools outreach. Community development.
10. 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. 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. 12. www.england.nhs.uk @robertvarnam bit.ly/nhs5yfv New types of organisation Multispecialty Community Providers Primary and Acute Care Systems
13. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 23. www.england.nhs.uk @robertvarnam
24. 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. 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. 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. 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. 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. 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