Lack of a single vision will always damage NHS practice outcomes

The lack of a single vision is, more often than not, the reason why a Primary Care Network (PCN), General Practice, or GP federation is falling short of the expectations of the Membership and the people working within it.

Without a coherent voice, we end up in a world of divide and conquer, people within our Integrated Care System not knowing who to listen to, and ultimately nothing moving forward.

So when I’m brought in by an individual practice, a PCN, or a GP Federation, my whole focus is very much on getting people to understand that the thing they need – above all else – is one single vision, with everyone pointed in the same direction. 

Too many voices can only mean confusion

A strong, single vision leads to a strong, coherent voice – for General Practice, this provides a single voice within the health economy. Without a strong and coherent voice, everyone gets a reduced share of voice, which risks decisions being made and System and Place levels without any input from General Practice/PCN because they don’t know who to listen to. 

When decision-makers do not join up, no one knows who to listen to, leading to divisions in approach. Practice 1 wants something different from practice 12, which wants something different from practice 6. Or it could be the five networks that all want something different. Nobody knows who to listen to, and it stands in the way of progress. It’s a real risk, and I’ve seen it happen numerous times.

Building a strong base

One collaborative group absolutely nailing this ‘one vision’ principle is in North Warwickshire, where I’ve worked with Primary Care Warwickshire Ltd for one day a month for the past seven years.

Primary Care Warwickshire is a GP Federation of 22 practices that work with the Primary Care Networks, the clinical directors for the networks, and the managers for the networks. They also work with the Local Medical Committee. 

The board of directors for the federation is laser-focused on creating that one strong, coherent voice for General Practice, and they have made sure that all levels were covered from practice to network and up to federation – the entire place footprint within Coventry and North Warwickshire Integrated Care System.

Supporting the practices to take the pressure off

As well as representing their 22 member practices, the federation also supports the practices to provide additional services right across the entire population of North Warwickshire. The services are sometimes on subcontract from the local hospital and sometimes directly commissioned by what was the CCG and now the Integrated Care System. 

They’re continuing to make progress on further subcontracts from the hospital and the mental health trust. They’re planning new services that help alleviate workload pressure on the practices, the absolutely key goal. Everything they do is about reducing waits for patients, faster access, more rapid diagnosis leading to rapid treatment, and alleviating workload pressure on the Member Practices. 

They work more often than not through the networks when that’s the right thing to do, but there’s also nothing hard and fast. They are flexible, highly collaborative, and very much focused on the patients and the practices. So if the network’s not the right scale to work at and it should sit at individual practice level, that’s where the focus will be. 

It took them time to get there. This shift doesn’t happen overnight, and it hasn’t been without its challenges. But the key is that they’ve got a strong federation board, they’ve got strong network leadership, and a thriving relationship with the LMC, which means they avoid clashing with them or working on the same services but in different ways. The relationship with the LMC is as strong as anywhere I have seen, and it’s a credit to all involved. It has been like this right from the start of developing the federation. 

Direct commissioning with the CCG

They have focused on demonstrating the added value that high quality, standardised and consistent service delivery without unwarranted variation can achieve. They very quickly developed a strong reputation for the practices, networks, and federations as providers. And it was that that led to the subcontracting and the direct commissioning with the CCG.

The practices and networks are fully behind the federation’s board of directors, they don’t have detractors, and they’ve nobody speaking out of turn or undermining the company. If an issue arises, it stays internal and gets dealt with exactly as it should be.

And when any project or proposition is put forward within North Warwickshire, the response is consistently: “Have you talked to the federation?” because they cover all the networks and all the practices, and they work collaboratively and productively with the LMC. 

Stick to the plan if you want to succeed

One last point worth making is that the North Warwickshire board has a business plan, and it sticks to it. They are not distracted by people turning up with offers and ideas. If it doesn’t fit the business plan – or give them a good reason to change it – then it’s off the table. This plays a significant role in helping them to move forward.

They start things and see them through. They get them implemented, measure and evaluate their success, act on any shortfall, deliver what they said they would deliver, and cost everything properly. There are no loss-making services, and they are not afraid to decline an offer if it doesn’t add up. 

Prepare now for Enhanced Access for Primary Care Networks

With enhanced access for the primary care networks due to commence on October 1 with plans to be submitted by July 31, they are already collaborating at every level to pull the enhanced specification apart. 

It’s early days, but they are already working out:

• What they are required to do
• How they will deliver those requirements
• Who is responsible for what? What practices are responsible for, what networks are responsible for, and what the federation is responsible for
• And the role the commissioner, the hospital, the out-of-hours staff, and everybody else in the health economy will play.

They have started to survey the entire workforce to see if they can get enough people willing to work 6.30pm-8pm Monday to Friday and 9am-5pm on Saturdays. And they are thinking about the service ideas stakeholders have already put forward.

My advice has been to focus on what the practices are struggling to deliver to see if they can create additional capacity and enhanced access. Some of the more obvious areas of focus from my work across England include:

• Acute GP clinics
• Minor ailments
• Vaccine clinics
• Smears
• Immunisations clinic
• Bloods
• BP checks
• Steroid injections
• Diabetes/foot checks
• Wound care
• LARC (Long-acting reversible contraception)
• Sexual health
• Spirometry
• Asthma
• COPD
• Heart failure
• CKD
• Allergies

They’re looking at the outcomes they are expected to deliver, how they’re going to measure and evaluate, and then how they’ll act on any shortfall. 

Everybody on the same page

They have the ability to do all this effectively because they have one clear vision. They know and understand what they are trying to achieve. Where that’s not the case, we end up with three or four or five or twelve different visions, and while everybody thinks they’re all trying to achieve the same thing, the opposite is happening. 

One company, one vision, one voice – that’s the essential recipe for success and the first place to look if you’re not achieving the outcomes you’re expecting. 

Scott McKenzie helps GPs, PCNs, GP federations, and Integrated Care Systems to build sustainable and resilient practices and processes that work cost-effectively and efficiently to produce better outcomes for all. If you’d like to find out how Scott can support your organisation, schedule a call today.