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Let’s end 10 years of no change

"Progress always involves risks. You can't steal second base and keep your foot on first." Frederick Wilcox, writer.

I was presenting at the GP Federation Showcase last week, and whilst listening to the other speakers, I was struck by one thing that one person said; one of their slides was 10 years old from 2006: and nothing has changed in 10 years.

The speaker was absolutely right.  All a bit depressing and sobering really.

Yes, I know that there are areas where change has happened, generally in relation to specific services and teams, where a genuine and real difference has been made to service delivery and to the patients on the receiving end for that something very specific.  The NHS Academy of Fab Stuff collaborates to celebrate and share these areas of best practice, and rightly so.

But the problem is, for all these examples of good practice, the NHS – in fact the entire care system – is in the grip of a downward spiral nose-dive.  Despite the best efforts of all of us committed to delivering change to make sure care improves and make best use of increasingly scarce resources, it just doesn’t seem to be working; even well-run Trusts that have never been in financial deficit, are now projecting eye-watering overspends.  As for the box-ticking, finger in the air, think of a number and make the plan fit STPs, that the majority of GPs have had precisely zero input to; don’t even get me started!

However, for all this doom and gloom, there is a light glimmering at the end of the tunnel, and that comes in the form of Primary Care Home and Community of Practice sites.  Coming with the caveat that CCGs (which need to be eradicated or emasculated – and given the politics, the latter option seems to be the most likely) don’t carry themselves on in their usual obstructive, governance, subcommittee, terms of reference and general blocking kind of way, these really could be the answer to the prayer that needs to be answered if we are to rectify 10 years of no change.

I strongly believe that if you put GPs in charge of a budget they will work together to make a difference.  Yes, we all know that primary care is changing, probably beyond all recognition of even 5 years ago, BUT it remains that General Practice still has that gate-keeping role.  GPs know their patients, know their patients’ families, know their circumstances, and probably most importantly of all, know and understand the communities in which they work.  They genuinely know and understand what works and what doesn’t work, and they know – they really know – how to make limited funds stretch: make services wherever possible and only buy services when needs must.

And yet, for all of this, they have been largely ignored by those writing STPs; organisations who are too busy saving their own skins and playing the politics of “giving the right answer” to actually stand any realistic chance of changing or delivering anything new or innovative.  Doing that, or dumping copious quantities of un-resourced and unsafe work on primary care.  CCGs, you most of all had the opportunity to engage all stakeholders and appear to have chosen not to do that, which is likely to result in the failure of STPs.

I say: bring on Primary Care Home and put GPs, as providers not commissioners, in charge of managing resource and spend.  Make them truly responsible and accountable; they will rise to the challenge – no question.

The Rapid Test Sites that are up and running have already started to make a difference.  They know that by focussing on biting off more than they can chew at the outset is a mistake; do lots of small, successful, genuinely collaborative things that make a big difference is the place to start.  Then begin to string those things together and start creating a whole.  Engage, enable and set free the people and communities who deliver and receive care as joint stakeholders and 10 years of no change will end, and we will really start to bring about the change we need.

Strong Primary Care Homes will become the hubs that bind together to form Multi-speciality Community Providers, in essence, the Primary Care Homes allows the creation of the interdependency I have talked about a number of times, as it requires collaboration on the road to integration, an integration that is unlikely to ever be made in one leap.

As ever, genuine, meaningful entire stakeholder engagement is needed in this – whether it’s 9, 900 or 9000 it can and must be done; front line, receiving end, backwards. Whether engaging with us to support you is at the beginning of the process or mid development, the outcome of participating in our innovative approach will be a fully engaged and motivated community, committed to ensuring that your organisation and plans are successfully implemented.  Not only this, but by adopting our model to change and development, you will have sustained resilience and have the tools to cope with future challenges and change.

Let’s end 10 years of no change and move to provider general practice-led change that will make the difference to the care system that’s needed.  I’m up for that: are you?

If you are thinking of developing an at scale provider organisation, or about delivering any form of change, and are looking for a model to engage every stakeholder in that change, and would like more information on how BW Medical Accountants can support you, or to arrange to speak to one of our experts please contact or call 0191 653 1022.

Additionally, if you should have questions for us please email and we will do our best to answer these within the blog.

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