Knocked back at every turn when you try to introduce innovation into your practice? You are not alone. But, in his latest blog, Ben Gowland clears a bit of wood so you can see the trees and presents five steps to introducing change…

Everyone in general practice agrees things need to be different, but as soon as specific changes are mentioned barriers go up. Words from Sir Sam Everington declaring the need for Skype consultations to become the norm in general practice send shivers down the spine of most GPs. Likewise declarations that the traditional partnership model is dead, and that “super-practices” and their ilk must become the new norm.

GPs readily admit the need for change, for innovation, but not Skype consultations or super-practices. Or telephone consultations. Or physicians associates. Or social prescribing (whatever that is).

How do practices wanting to make change overcome this particular problem? In the flat decision-making structure that makes up most GP partnerships, overcoming this type of resistance is especially challenging, because not everyone wants to take risks, not everyone is on board, and focus on the bigger picture easily gets lost.

Let’s take an example: the employment of a clinical pharmacist by a GP practice. Let’s say one partner is particularly in favour, and puts forward the case. Some partners are not going to want to take the risk. They are going to see the (definite) financial outlay with an only probable financial return. Some will be against the idea on the grounds that a pharmacist can’t possibly do the job of a GP (I know they are not trying to, but you can picture the discussion).

The discussion goes on. The longer it goes on, the less it is about tackling the problem of unmanageable workload, and the more it is about whether taking a risk on a pharmacist is a good idea. The vision is lost, and the focus is on the detail. Eventually, after a long discussion by the partners, the practice decides to pass on the opportunity to employ a pharmacist. Everyone still agrees innovation is needed, just not this one.

It is not always like this. I have spoken to a large number of practices that have successfully introduced innovations and changed the way they have done things. I have asked them how they did it, and how they managed to overcome the barriers others could not. I have grouped what they said into 5 steps to introduce innovation in a GP practice:

1. Don’t start with the solution, start with the problem. Any practice looking to make changes will be doing so for a reason. If the workload is unmanageable, the workload is unmanageable. Focus the initial discussion on this as the problem, and establish a sense of urgency that something must be done. Be clear that no change is not an option.
2. Develop options. Giving a choice of options empowers decision makers. Listening to the arguments of those against an option can help develop even better options. In our pharmacist example we could offer a range of different roles, or reduced drawings to fund extra GP sessions, or merger with another practice as ways of coping with the unmanageable workload. Keep the focus on solving the problem, not on any specific solution.
3. Create a critical mass of support. There will nearly always be someone in any GP practice who is against whatever the change is. Once it has become clear which is the best option it may be that those most in favour of the change need to do some work outside of the meetings to firm up support for the change. It is all too common for one all powerful voice to continually veto the introduction of any meaningful change. Where this is happening others need to work together and plan how to get the final approval required.
4. Create a worked up solution that reduces risk.  A good way of getting the change to happen is to provide a way out, whether that is a review after 6 months or a short term contract before offering a permanent one. At this point the work of those in favour of the change is only beginning. They need to mentor and support the new recruit, manage their introduction into the practice, support their professional development, and problem solve with them. The experience of those who have done this is that 6 months later the practice can’t imagine how it ever coped without the new member of staff in place.
5. Use one successful change to enable further change. When practices agree to make one big change, and have a positive experience of it, they are much more likely to take a risk on the next one, and make further and further innovations. It is no coincidence that practices who introduce new roles are often larger, building whole system partnerships, and looking for ways to make the new models of care work for them.

Identifying innovations is relatively easy. Getting them to happen in your practice is not. The innovation problem in general practice is not a lack of ideas, but the difficulty of adoption, and of changing the behaviour that goes with it.

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