A few weeks ago I wrote about how AccuRx had changed general practice over the course of a single weekend.  What can we learn from the achievements of a relatively small company like AccuRx, in contrast to the traditional ways of working in the NHS?

The most striking feature of the way AccuRx work is that they do not try and control how the innovation they create is used.  Their belief is that if you prescribe how something is to be used, you actually prevent innovation.

The core AccuRx product is the text messaging service.  They linked the service with the individual patient and their record, but didn’t prescribe how or when the service was to be used.  When practices were working out how to see potential covid patients face to face, some put signs in the car parks for patients to wait in their cars until they received a text message when they were ready to be seen.  Not a way of using the product the company could ever have foreseen!  Innovation in the use of the product came from the GPs and the practices, not from the company.

Equally with the video consultations, practices sent the link for the call to a family member who could interpret for the patient when they didn’t speak English.  In hospitals, it was used to enable virtual visits by relatives not able to visit in person.  Innovation was generated by front line staff, enabled by the initial development.

By resisting the urge to control and dictate how the change was to be used, far more innovation has developed as a result.

In general practice local teams in many parts of the country were allowed to work out how to respond to covid.  “Hot hubs” and the like were developed and locally tailored and implemented in days and weeks.  Without central control, frontline innovation prospered.

This is in contrast, of course, to how we normally introduce change in the NHS.  The urge always is to control.  Trusting front line staff to innovate feels risky because it cannot be predicted.  So what we do is insist on business cases that detail not only the change to be introduced, but exactly how it is be used and implemented, and the predicted impact that will result from the prescribed changed.  The more we control the change, the less risk we feel, but at the same time the more we suppress any wider innovation.

Let’s take PCNs as an example.  The basic change is to enable practices to work together and with local partners to improve outcomes for local populations.  But as an NHS we can’t leave it at that, and allow practices to use the change and innovate locally.  The urge to control is too great.  So instead we have template legal network agreements, detailed service specifications (remember the December drafts?), and maturity matrices.  The NHS attempts to control how PCN will operate, what they will do, and the way in which they will develop.

Resisting the urge to control is very difficult in the NHS.  Senior staff are consistently reminded that they are “accountable”.  The pressure to minimise and control any financial risk is immense, and leaves little room for trusting local staff and teams to innovate.  But the lesson from the success of AccuRx is that less control is exactly what is required to foster greater innovation.