Leading from the front in primary care

12 April 2016

In a recent interview, former Secretary of State for Health, Kenneth Clarke said:

“You can declare war more peacefully than you can reform a health system” and

“It is such a giant organisation [the NHS]…which they were trying…to run centrally and bureaucratically, with a bureaucracy that wasn’t up to it. Six thousand officials, God knows what they all did, trying to run it centrally”.

Here lies the key issue. We have clever policy makers at the centre, but they do not deliver a front-line service. Edicts from above largely blow by front-line staff who spend their time treating the sick, not pouring over central demands to produce ‘logic models’.

Of course we are all part of a larger thing, but is it a ‘system’ as it is often described? I say not. It is more complex, more organic, more nuanced than ‘system’ implies. Trying to mandate change from above has largely failed – and failed on a regular and spectacular basis.

We need a different approach – one that is ground-up in its design and delivery.

Over the past two years Lakeside Healthcare, which provides care to 100,000 patients across the East Midlands, has been reinventing itself as an organisation that can meet the growing demands of our patients: one offering attractive careers to all our staff, and better value for taxpayers. We are doing this, no-one else is helping, and we are doing it from within our own resources.

A year ago Lakeside was selected in the first wave of NHS England ‘vanguard’ sites. NHS England called us a ‘Multi-Speciality Community Provider’. We call ourselves ‘Primary Care’. Over the next 12 months we continued at our own pace, funded by ourselves as we have received no extra ‘vanguard money’, developing what we believe the best answer to our £30 billion killer question.

Our plan is simple: we offer more time, more care, on a more regular basis to our most needy patients. We offer a number of additional services (for example, urgent care) in community settings that offer quicker, better access at a lower cost. In short, we are prepared to take full responsibility for the health maintenance of all those on our general list (and hopefully get the accompanying budget to manage).

To do this we needed to be bigger. Bigger gives us economies of scale across a number of management functions, including IT, HR and payroll, finance, and operations. Bigger means we can free up appropriately trained GPs to become specialists and lead new services. Bigger makes our business model more resilient.

Bigger means we can offer a comprehensive teaching and training offer, not only to GP registrars, but also physician associates, nurses, pharmacists and secondary-care clinicians. Bigger means we provide x-ray, ultrasound, pathology labs and observation bays – facilities funded by us that make a massive difference to what we can do for our patients.

Combine all these things, wrap them in our five-year strategic plan and you start to have something special – something others want. Something we own; something we can deliver.

We have a healthy reputation for attracting both senior and junior staff as we are an exciting place to work. Scale that up and we are attracting whole practices that want to merge, not federate, with us. This is because we offer a future, a purpose and a plausible road map for the sustainable future of primary care.

Over the next 18 months, we shall be adding more practices and more patients with a mid-term target of 300,000 patients. This is do-able. One single practice, owned by staff, delivering great care across a big geography, including most clinical services required by our patients.

My advice to other ambitious primary care organisations is: DIY.

Don’t wait for central benediction; don’t wait for handouts; don’t believe there is a central answer. There isn’t.

With all the above points in mind, I was delighted to join an Advisory Board working with healthcare thought-leaders at Reform and other NHS colleagues to write a paper on the future of general practice. Reform’s findings are really important: general practice does have a promising future, but it will struggle if we continue with old ways of working. The conclusions of the report support the direction we and others are taking.

That is something we should all care about.

Professor Robert Harris is Chief Executive Officer and Partner of Lakeside Healthcare.

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