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NHS - How many reasons do you need to drive a change?

"Ideas are a dime a dozen. People who implement them are priceless.” Mary Kay Ash, Entrepreneur

In reality, I don’t think there is a right answer.   For some, one may be enough, for others it may take many more.

I am certain if I had 26 reasons for not staying where I was I would make the change, particularly when the risk had been mitigated to a point where it could be safely managed, and the risk of staying put was much greater than that mitigated risk, or in fact the likely reward of changing.

Yet that is the reality I have encountered recently. A group of practices located within proximity of each other, acknowledging and very concerned about the 26 reasons why they couldn’t stay where they were, and yet all attempts to get agreement to form a super practice failed to achieve that outcome.

All health and social care policy direction is for collaboration, integration and working at scale.  When this is developed as policy makers intended, it works well – really well – with patient care improving, efficiency improving, and the working lives of those delivering the care improving, making working, and remaining working, in that environment much more attractive.

We all know that this is true, and the evidence and exemplar from this and earlier efforts at integrating care prove that.  So why is it so difficult for all but a relatively few excellent examples that demonstrate it can be done?  It shouldn’t be the case that the shining lights stand up at conferences and tell us all how it’s done, because we should all be doing it.  It shouldn’t be the exception; it should be the rule; the norm; nothing out of the ordinary. And yet it is.

I go back to the example of the practices I referred to at the top of the piece.  Practices that get on well, who know each other, who are struggling with ever increasing workloads, reducing income, higher expenses and the challenges of recruitment, and recognise it.  They spent significant time, energy and money working out how they would join together, create efficiencies and attract a workforce. They had it all agreed, in great detail, with a clear project plan and time line. But at the 11th hour, 59th minute and 59th second, for reasons that only they can justify and rationalise, they changed their minds.  “We’re ok at the moment”, “The time isn’t right”, “We’ll leave it 12 months and then we’ll definitely probably look at it again.”

It’s not just General Practice either. You can look across the NHS and find Hospitals disappearing under workload, Community Services failing because they can’t recruit or retain, CCGs producing great plans for change, STP leads doing much the same, and yet they all stay stuck doing exactly what they are now – why is that?

My take on it is that the majority of these organisations know that they have to change and work differently, but until something actually forces them to do it (and by forces them, I mean really forces and mandates them), they won’t.  That force could be policy and rules, or it could be complete crisis and collapse.  Either way, it’s easier to carry on as you are than step out of a comfort (or lots-of-discomfort-but-I’m-just-surviving) zone, and embrace change in a proactive way, even though common sense tells you that changing while you can be proactive rather than reactive about it is a far more productive, effective and efficient way of doing it.

My strong advice is don’t wait until you’re forced to change; it’s highly unlikely it will give you the outcomes that you want, need, or intend.  Seize the opportunity to make and properly implement change while you still feel comfortable, even if that’s comfort on its limits, before you’re forced to, when you can think clearly and generate ideas that are sound and good.  Make sure that as part of that change process you genuinely and meaningfully engage all and every stakeholder that change impacts, and give those who want their voice and input heard the opportunity to do so, regardless of the number.  It will ensure that your vision and change is owned and delivered.

Change isn’t easy, but it’s necessary.  When you know it needs to happen, do it before you’re forced to, and don’t march to the top of the hill and just when you’re at the summit and ready to go over the hardest bit at the top, head back down the same way you came.  

It’s way better to do than to be done to; the care system needs to brave, put organisational differences and politics to one side, get out of the comfort zone and get on and DO.

If you are thinking of developing an at scale provider organisation, MCP, PACS, ACS, are heading towards ACO or are about to deliver 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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