In his second blog for us , independent management consultant Scott McKenzie looks into the questions around new models of care:

Following on from my last blog on New Models of Care, I was asked if I could share the 6 questions I use to engage General Practice, and if I had examples of this in action.

Scott Mckenzie

Independent Management Consultant

Six questions

For those leading the development of New Models of Care you need to stop and take time to ask:

What red lines General Practice has?

What they enjoy about the way they work now that they would like to see reflected going forward?

What things they might be flexible around?

What could be started quickly?

The needs of their local population?

The workforce and workload they have currently and would like in future?

To that I often add a seventh question:
What’s on their wish list?

Example process

This is the process that was used by one of my federation clients in the midlands, where the CCG had agreed the GP federation could lead the development of the 30k to 50k hubs (sometimes called Primary Care Home, networks, localities, neighbourhoods, or any other local name you choose to give them, the key is the population size of 30k to 50k as a start point).

Each Practice was engaged individually and asked the questions above, while also answering any questions or concerns from practices. Some of the practices chose to make the federation aware of the practices they would prefer not to be clustered with.

The federation then guaranteed that it would include all the input and feedback to develop the hubs and then the vision locally. All answers were handled anonymously, and hubs created on the basis of like minds, with all having “sensible geography”. Beyond the questions outlined above, your engagement of General Practice could include addressing many of the following points:

  • How you ensure sustainability by working together, as without this there is a real risk that some practices will become unviable

  • How you help, support and encourage the practices to engage and work with you. The NHS needs high quality General Practice to be successful and the current funding and income pressures are growing and will not go away

  • How you build on the strength of General Practice (more than just protect) as the home of Primary Care – what services can you introduce because of your new ways of working?

  • How you offer a long-term future to your current workforce through a workforce development plan for the short, medium and long term. This includes a focus on stabilising the workforce, and ensuring resilience and succession plans are complete. Into this you can add how you design and develop the roles of nursing, pharmacy, AHPs, and other members of the wider health and social care team

  • How you plan to deliver long term and sustainable change through a shift in mindset and work with practices to deliver the new outcomes required, underpinned by high quality training and education

  • How you will focus upon on improving outcomes for the population, both those known to services and those undiagnosed

  • How ultimately you will deliver integrated services in the community, with a shift from in hospital care to out of hospital care, most of which require consultants delivering care in different locations, with services differing in their scale, development and delivery. This requires General Practice to ensure they are enhancing skills, redesigning the workforce and redesigning the workload. There is no single right model of care for this; it must be based upon local circumstance and provide population-based care.

To be engaged in answering those questions requires the winning of hearts and minds; this is in respect of the purpose of the engagement, followed by the agreement of a joint vision that will be pursued within an agreed timescale. Anything less is at best nothing more than a meeting and at worst a waste of time, as it will not reach a conclusion and so nothing will change due to a lack of meaningful engagement.

More of that next time, where I will explain the engagement process we use to ensure nothing is ever done top down.