Persuading GPs to work together at-scale, in whatever form we prefer, is a challenge. It is difficult because people (all people, not just GPs) don’t like change. We all remain anchored to our past and the certainty that provides. We all have an aversion to loss, and are more concerned with losing what we have than the prospect of gain. And we all have a strong desire to hang on to what we have, because simply owning something makes it seem more valuable to us.

Why would GPs give up the certainty and security of working as an individual, autonomous practice, and start to hand over some of that autonomy and freedom to an at-scale entity? Why would they change the model that has barely changed in 80 years because suddenly someone else thinks the model needs to be different?

The leadership task of the at-scale organisation is essentially one of persuasion, of winning hearts and minds so that GPs and practices will decide to make this change. This act of persuasion is not about analysis, or a simple presentation of the facts. It is about inspiring people to implement new ideas in the future. And not just grudgingly but enthusiastically, because they believe in it.

So how do we do this? How do we take our own hypothesis (that by working together we can make general practice a better place to work, able to deliver better care for patients, and have more influence on decision-makers) and persuade GPs and practices to give up some degree of local autonomy, and maybe some of their own money, to test it?

It is all about the story we tell. To win hearts and minds we need to tell a compelling story. Where management is concerned with how we deliver the goals we set for ourselves, leadership is concerned with establishing those goals in the first place. It is about creating a consensus about the goals to be pursued and how to achieve them. Storytelling is not a replacement for analytical thinking, but it enables us to imagine new perspectives and so is ideally suited to communicating change.

The best stories to spark action are what Stephen Denning[i] describes as “springboard stories”. These stories are based on actual events, where someone else (preferably a similar group of GPs or practices) has made a change that has been successfully implemented. It includes an implicit alternate ending of what would have happened had the change not been made. It is told in a way that allows the listener to create an analogous scenario for change in their own practice (“what if we did this here?”).

Sparking action is only the beginning. But thinking about how we inspire practices to work together and make the possibilities come alive through the stories we tell is an important starting point. Doing it because we feel we have to, or because everyone else is, or because the CCG/system wants us to means we can have the names and structures in place but lack the energy or commitment to make any real change happen. Sometimes we need to go back to the beginning to move forward.

What is your story?

[i] The Leader’s Guide to Storytelling, Stephen Denning, 2005