23
oct
0

What single thing can have the biggest impact on GP resilience?

Posted by Blogs, The General Practice BlogNo Comments

I was talking recently to Dr Rachel Morris (who as many of you will know is a Red Whale presenter, coach, and specialist in resilience) as part of a conversation for her new podcast “You are not a frog” (which focusses on how to build resilience and thrive in challenging environments).  General practice is certainly challenging, and the question Rachel asked me was what can GPs do in such an environment?  What “quick wins” are there that GPs can take?

I reflected on all of the guests we have had on the General Practice podcast, and what is clear is that there are no magic bullets for general practice.  Changes that have worked for some have not worked for others.  Some practices hate telephone appointments, some swear by them.  Some love new roles, some think they simply add to the overall burden of work.  Some like to give the admin team more of the GP workload, but others find the lack of control adds to rather than reduces their stress levels.

There is, however, one thing that GPs who are working in practices that are thriving in the current environment have in common: the ability to make change happen.  I don’t think it is over-stretching it to say that a key part of developing resilience for GPs is the ability to make change happen in their own practice.

I recently interviewed Dr Liz Phillips on the podcast, and she talked about the transformational impact being able to make changes (for her as a partner, compared to 12 years previously as a salaried GP) has had on her.  Longer time listeners to the podcast may also remember the inspirational Dr Farzana Hussain talking about how learning how to make change happen using quality improvement techniques had given her the strength to carry on when she was left as the sole partner in her practice.

Resilience comes from the sense of control that when things are not working, they can be made better.  When problems are being faced, there is a way out.  When making change feels impossible, it is easy to understand why individual GP resilience can suffer.

Recently on the podcast Paul Deffley (in a must-listen episode) described his experience of making changes across multiple practices.  However, it was in his first appearance on the podcast that he described an experience of two practices introducing the same pharmacist to do exactly the same things.  One had made it work really well, one hadn’t.  The pharmacist was the same, and what the pharmacist was doing was the same.  The variable was the practices.  Why would one practice be able to introduce the change successfully and the other not?  Ultimately it came down to ability of the practices to make change happen.

Making change is difficult.  But it is not impossible.  Learning how to make change is a skill, and it is one that it is worth investing in developing because the benefits are so wide-reaching.  I remember my own ‘a-ha’ moment many years ago, when suddenly after 5 years of “managing” in acute hospitals I learnt the role was not simply to keep things going, to do the heavy lifting for a period of time until it was someone else’s turn, but to actually make things better.  I learnt the skill of making change happen, and it completely transformed my own experience of being a manager.

So when Rachel asked me what can GPs and practices do that will make the biggest difference in the challenging environment of modern day general practice, my response was to learn how to make change happen.  Whatever the challenges a practice might face, if it knows how to implement change effectively it will always have a route to overcoming them.

16
oct
0

Guest Blog – Karen Castille – 10 things coaching can do for you

Posted by Blogs, The General Practice BlogNo Comments

When your car won’t start you probably call out a mechanic. And when your drain is blocked it’s likely you’ll need a plumber to help you unblock it. But when might you require the help of a coach? Whilst it’s hard to describe what their role is, it is certainly not to fix things for you!

As it is notoriously tricky to explain what a coach does, it is probably better to flip the question and, instead, describe how the process of coaching might help you.

The coach’s job is to help you move closer to achieving things you want for yourself. However, most of us have a natural tendency to focus on problems rather than on bigger more strategic and longer-term goals that will help us to grow and learn. So I use the mnemonic ‘A.C.E.’ as a reminder of the three possible areas of focus if you work with a coach:

A – an Aspiration, goal or dream that you have

C – a Challenge, problem or issue that you need to rise to or resolve

E – an Experience or event that you want to make sense of

The ‘A’ is future focused; the ‘C’ is mostly present focused; and the ‘E’ focuses on the past.

Based on many years of coaching, here are ten things that most of my clients ask for help with and which usefully describe how a coach might help you.

Aspirational Things (hopes, dreams and longer-term goals)

1. Provide clarity about what you want, then create a tangible plan of the steps you will take to get there.

2. Work out what’s most important to you (rather than focus on the urgent things in front of you now), especially those things that will help you create a more positive future.

3. Determine what success looks like (for you) and embed this into your longer-term goal.

4. Create excitement, momentum and focus to help you move closer to your goal.

Challenges

5. Build confidence and competence in solving your problems and making decisions about things that are troubling you or keeping you awake at night.

6. Help you to stand outside of the problem, rather than being in it, by questioning your assumptions and helping you think about it from different perspectives so that you can consider different solutions.

7. Work out your options – especially if you feel stuck or that the challenge is impossible to overcome – then create commitment to acting on one or more of your ideas.

Experiences or Events (either negative or positive)

8. Reflect on and make sense of past experiences or situations. This can help you to learn from mistakes and let go of things that are out of your control.

9. Help you discover things about yourself that you may not be conscious of such as:

  • Your leadership style and preferences
  • How you deal with challenging behaviour or conflict situations
  • What works for you (and what doesn’t!)

10. Build positive and productive relationships – even with people you don’t get along with – by reflecting on their behaviour as well as your own.

People who have undergone coaching often talk about it being a life changing or transformational experience. But don’t misunderstand me. It is certainly not a cosy chat over a comforting caramel latte! It requires hard brain work and for you to take responsibility for your life and your future. It needs courage to try new things, and commitment to make changes to the way things are.

This said, when the coach and coachee work well together, it is certainly worth the effort.

Unfortunately, you’ll still need to call out a mechanic for your car, or a plumber for your blocked drain. But with coaching, futures get sharply defined, careers get changed, problems get solved, work-life balance can be restored and, importantly, sleep comes more easily!

Dr Karen Castille O.B.E, Executive and Leadership Coach, Author The Self-Coaching Workbook, @karencastille

9
oct
0

Are PCNs the new unit of GP improvement?

Posted by Blogs, The General Practice BlogNo Comments

The question of whether Primary Care Networks (PCNs) are to replace individual practices as the focus for improvement in general practice is an important one.  If the answer is yes, it potentially represents a direction of travel whereby the focus on the individual practice could be significantly reduced, and (conversely) the opportunities for practices through PCNs could increase way beyond the level set out in the contract.

I asked Robert Varnam, Head of General Practice Development at NHS England, in a recent interview for the General Practice podcast whether PCNs are the new unit of GP improvement.  His response was that while there is a focus on the unique and individual needs of each practice at present, we are in a period of “transition” from practices to PCNs, and are moving increasingly towards working with practices as a group within their individual networks.  The rationale is that when practices collaborate they can generate more ideas more quickly, they can build shared resources that prevent things being done multiple times (e.g. training, directories of service etc) and networks create a route to accessing resources like new roles, that for some practices have been out of reach while working on their own.

Within such a transition, how will the focus on the specific needs of the individual practice be maintained?  This responsibility is likely to fall to the PCN itself.  The ‘system’ will support the PCN, and it will be the role of the PCN to support its member practices.

The question then for the PCN is how it intends to support its member practices.  There are two potential routes open.  One is to use the PCN as an exercise in collaborative improvement for its member practices (and the populations they serve).  The second is to treat the PCN as a bureaucratic hurdle to be overcome to secure resources for member practices.

It is the role of the practices in each PCN to decide what the right balance is for them, and which of these routes they want to go down.   I suspect the assumption made in some STPs and in some quarters nationally that all practices are opting for the former rather than the latter of these two routes is unlikely to be right.  The differing attitude of PCNs to the £1.50 running costs is illustrative of this, as some PCNs are spending as little as possible to maximise the resources that remain for practices, and some could have easily already spent the £1.50 twice over as they embark on a series of different local change initiatives.

Underneath this choice is a question each practice needs to grapple with on its own, which is in light of this overall national direction and given the challenges we face how will we make improvements to our practice?  Will we do it on our own, using the (increasingly limited) resources that will be available?  Or will we do it through the PCN, using the opportunities that brings?  Is it to be done at a practice level whenever we can, and a PCN level when we have to?  Or PCN level whenever we can, and practice level only when we have to?  The mindset here is key.

The PCN route brings resources such as new staff and new investment, as well as the opportunity to make bigger, bolder, more impactful changes.  But as ever there is a trade-off, as individual practice autonomy is reduced, there is less individual control on changes happening across a larger group of practices.  And, inevitably, the more GPs that are involved, the more difficult introducing any change can be.

So far PCNs have been largely about set-up and getting the fundamentals in place, and the opportunities for improvement have not yet been widely exploited.  What remains to be seen is whether practices will choose to use PCNs as a collaborative opportunity to create a general practice that can thrive into the future, or whether PCNs end up as a largely administrative exercise that serve a wider purpose but do not really help core general practice.  PCNs may be the perceived unit of general practice improvement going forward, but ultimately it is up to practices to decide whether this is a route they are prepared to travel down.

2
oct
0

Why PCNs are difficult – Part 2

Posted by Blogs, The General Practice BlogNo Comments

In the world of start-ups, the mantra is that any new idea has to solve a problem. Google solved the problem of finding things on the internet, while Amazon solved the problem of buying things on the internet. But start-ups that begin with a solution and search for a problem to solve are the ones that find life much more difficult.

Google Glass is a classic example. It failed because the creators neglected to define what problems it was solving for its users. There was not even a consensus among the creators about what the core use of Google Glass was. One group argued it could be worn all day as a fashionable device while another thought it should be worn for specific utilitarian functions. They assumed the product would sell itself, and that its hype would be enough to appeal to everyone. But in the end, Google Glass did not provide enough advancement for users compared to older technologies (phones), making the product a useless supplement to their daily lives.

There are some interesting parallels between Google Glass and Primary Care Networks (PCNs). There is not a clear consensus as to the core purpose of PCNs. The wider system wants them to be a mechanism through which general practice is “integrated” with the rest of the system, and the GPC want them to be a mechanism for greater investment into general practice. There is an assumption that by channelling resources through PCNs it will make them successful. But in the end, if PCNs do not make a big enough difference to member practices, success is by no means guaranteed.

PCNs need to work hard to avoid being a solution looking for a problem. Because success depends so heavily upon the engagement and participation of member GPs and practices, they have to define themselves early on as the solution to the twin problems of workload and financial viability. These are the problems in general practice that need to be solved, and working at scale, introducing new roles, and working with the rest of the system are proven solutions, and all (potentially) encapsulated by PCNs.

But the reason PCNs are so difficult is that change is not that straightforward. You can’t start with the solution (PCNs) and expect practices to buy in straight away. Changes succeed or fail as a result of understanding the problem, and building confidence that the solution offered can make a difference. If operating at scale was that easy, we wouldn’t still have 7,000 individual GP practices. If introducing new roles was that easy, they would be much more widespread across practices. If working with the rest of the system was that easy, we would have more than a handful of examples of practices working in partnership with acute and community trusts.

The challenge, then, that largely sits with the new PCN Clinical Directors, is to do the work to understand the specific problems facing local practices, and to convince the local GPs that by working with and through the PCN these problems can be tackled. Without this, PCNs risk being a solution looking for a problem, and ending up the same way as Google Glass.

25
sep
0

Which is better? A Federation or a Primary Care Network?

Posted by Blogs, The General Practice BlogNo Comments

The rapid emergence of Primary Care Networks (PCNs) has led practices in many areas to consider the question of whether they are better off as part of a federation, or whether it would simply be better to go it alone as a PCN. So which is better, a PCN or a federation?

What criteria do you use to make this decision? Generally, it comes down to a “what have the Romans ever done for us” consideration. Has the federation/PCN had a beneficial impact on practices? Or does it feel like an entity ploughing its own furrow without really impacting on member practices?

The answers to these questions will vary locally. But the opportunity federations and PCNs can provide for member practices is clear. Federations can provide an organisational structure that PCNs (that are not legal entities) can harness to employ staff, manage risk, and take away any personal or practice liabilities. They can deliver benefits of operating at a greater scale than PCNs, such as attracting higher calibre staff, establishing central functions (such as finance and human resources), and reducing costs through better purchasing power as well as attracting funding for general practice. They operate at a scale where they can build and maintain organisational relationships with all of the local health and social care organisations in way that an individual PCN cannot hope to. General practice itself can have a much stronger voice in the system if the federation is speaking on behalf of all practices, where six PCNs wanting six different things can quickly dilute the collective voice of the profession.

A PCN on the other hand can have a much closer and more intimate relationship with its member practices. It can take time to fully understand the individual challenges each of its practices is facing and take tailored action to support them. It can be nimble and change direction quickly. If the focus needs to change from one challenge to something more pressing it can be reactive and responsive. Each practice can be part of the decision making, and understand exactly what has been decided and why. There can be a transparency about funding, use of resources, and exactly where everything is going. They can make change happen at a local level in a way federations could never hope to, because of the relationships they have in place.

For those of you with longer memories, you may remember back in the days when CCGs were being formed one of the key questions was – what is the right size of the CCG? Should they be small and closer to practices, or should they be large and able to consolidate resources and the available funding to maximise the impact the CCGs could have? In the end both arguments were right: the smaller CCGs didn’t have the resources, influence and financial stability needed to be effective, and the larger CCGs quickly became distant from practices.

The lesson here is that you need both. You need to be large to be effective, and you need to be small to remain relevant to local practices and local populations. The incredible opportunity that general practice has in areas which have federations in place is to have both: they can use the federation to achieve all the benefits that size requires, and the PCN to maintain the localism and energy to drive locally relevant change.

The difficult question, then, is not whether a federation or a PCN is better, but how to bring federations and PCNs together in a way that maintains the trust and confidence of local practices, and allows the two to work effectively together for the benefit of all.

Page 41 of 76
1394041424376