I had intended to explore how you agree the remuneration for those involved in the board of a federation; however, will return to that topic at a later date, as something more pressing has come up, namely joint working with the Pharmaceutical Industry.
For those who know me, you will recall I worked in Pharma from 1995 through to 2005, meaning I have insight on the other side of the fence. While I recall the days of Medicines Management being introduced, and the high hopes we had for a bright future of formal engagement with Pharma as an industry, this has unfortunately never really materialised. Additionally, while the name has changed to become Medicines Optimisation the same process of cost containment is being played out, and if anything the entire industry is now even more remote from the NHS than it ever has been. I have never had so many old colleagues coming to me with excellent ideas and projects that are quickly dismissed as "unviable" by CCG teams, without any testing.
I can't conceive of any other industry where one of the largest suppliers would ever be treated in such a way, and something has to change. For me, the advent of GP Federations may just provide that catalyst.
The GP Federations are new companies with commercially aware leaders who see the VALUE in projects not just the cost. They are willing to engage on behalf of their membership (many covering entire CCGs) in a way that the CCG and Medicines management / Optimisation simply will not consider. The reassurance of the ABPI code is proving invaluable in helping people to understand that as an industry the code helps police the system, and has all but eliminated the ways of the past. Indeed, the Pharma Companies tend to be more worried about the implications of things going wrong that the Federation Leads.
The GP Federation is of course a whole new client base for Pharma, and one that is willing and able to engage. I have a number already looking at how they might bid to take on the running of Medicines Optimisation such is the level of dissatisfaction currently - indeed, I have one that is developing a proposal to work in a radically different way that would see the Management of the Medicines Team made redundant. They are completely confident they can deliver a better job by working smarter and in partnership with their members and the industry.
If "The definition of insanity is doing the same thing over and over again and expecting a different result." - Albert Einstein the opposite to the quote means that to do something different you have to do something you have never done or tried before. This means getting people outside of their comfort zone and actively pursuing a different course of action.
In life in general the reason for major change failure is embedded behaviours (culture) from the past preventing the new strategy from delivering. A strategy therefore has to be strong enough to overcome all the cries of….. but that's the way we have always done it, and at the same time withstand the pressure to revert to type (the comfort zone) the first time the new way of working meets an obstacle.
Time then for a radical re-think of the delivery models, which is exactly what a GP Federation is there do.
The Federation work supports practices to tackle the very real and present threat to General Practice in the form of reduced income, and the requirement for pretty much everything beyond core contract now requiring to be bid fro through AQP. Federation is therefore possibly the biggest opportunity for General Practice there is at the moment, without this General Practice is quickly going to find itself working on core contract and nothing else. This also makes federation one of the biggest opportunities for Pharma, where we might at last see the type of joint working initiatives and outcomes intended, when back in early 2012 Joint Working - A Quick Start Reference Guide for NHS and Pharmaceutical Industry Partners was published by the ABPI, NHS Confederation and DH working in collaboration (the history of the NHS is littered with documents such as this, all gathering dust where little has changed).
We have a number of Federations now working in genuine partnership with Pharma to deliver high quality projects, consistently well across all member practices, without variation and delivering fantastic outcomes for patients and the NHS alike, and I am certain this is only going to grow.
Before those working in Medicines Optimisation decide to shoot the messenger; the examples are there in my work, where the Federations know doing more of the same will only lead to financial problems and taking a risk may just be their salvation. They have accepted - as stated by Seth Godin (of Purple Cow fame) -that "it is safer to take a risk" (than sitting tight and hoping, when you really know in your heart what you are doing is not working). This of course also provides an opportunity for those in Medicines Optimisation who are willing to take a risk, break out of the comfort zone and try something different.
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