The contribution of GP leadership and wider primary care teams in improving local systems - resources and learning from NHS IQ's Transforming Care team. Speakers: Dr Tom Margham and Mani Dhesi.

1. Making change happen at the sharp end.
The role of GPs and the primary care team
in improving local systems.

2. WHY

3. MY
WHY

4. OUR
TEAM
WHY

5. HISTORICAL
SECONDARY CARE
NATIONAL
IMPROVEMENT FOCUS

7. Went back to underlying improvement
principles then built approaches with
Primary Care for Primary Care

8. WHY?
WHAT?
HOW?
https://www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action?language=en

9. WHAT
HAVE
WE
DONE

10. CCG work
with senior
system
stakeholders
Prime Ministers Challenge Fund work with
frontline Primary Care staff and patients
Place based support –
working with senior teams
and frontline Primary Care
staff & patients

13. CCG work
with senior
system
stakeholders
Prime Ministers Challenge Fund work with
frontline Primary Care staff and patients
Place based support –
working with senior teams
and frontline Primary Care
staff & patients

17. CCG work
with senior
system
stakeholders
Prime Ministers Challenge Fund work with
frontline Primary Care staff and patients
Place based support –
working with senior teams
and frontline Primary Care
staff & patients
MIND THE GAP

18. CCG work
with senior
system
stakeholders
Prime Ministers Challenge Fund work with
frontline Primary Care staff and patients
Place based support –
working with senior teams
and frontline Primary Care
staff & patients
UNTAPPED LEADERSHIP
CAPACITY

19. CCG work
with senior
system
stakeholders
Prime Ministers Challenge Fund work with
frontline Primary Care staff and patients
Place based support –
working with senior teams
and frontline Primary Care
staff & patients
SUSTAINBILITY
ISSUES

20. CCG work
with senior
system
stakeholders
Prime Ministers Challenge Fund work with
frontline Primary Care staff and patients
Place based support –
working with senior teams
and frontline Primary Care
staff & patients
LOSS OF ENERGY
(Fuel for change)

21. CCG work
with senior
system
stakeholders
Prime Ministers Challenge Fund work with
frontline Primary Care staff and patients
Place based support –
working with senior teams
and frontline Primary Care
staff & patients
FILL THE GAP

22. CCG work
with senior
system
stakeholders
Prime Ministers Challenge Fund work with
frontline Primary Care staff and patients
Place based support –
working with senior teams
and frontline Primary Care
staff & patients

24. Shared
purpose
Narrative
Measurement Creative
thinking

25. Shared purpose

30. What is your personal ambition for the
piece(s) work that you are doing at the
moment?
Share a fact that your work colleagues are
unlikely to know about you.

31. How do you make this happen
• Time out from everyday practice
• (Ideally) a neutral space
• Facilitation – a neutral broker
• Honest conversations

32. Narrative

33. Creating your compelling
narrative (story)
to help you engage others

34. a skill to motivate others
to join you in action
A narrative approach may help?

35. PROJECT INITIATION DOCUMENT
- Run searches on practice population
- Undertake case note reviews on patients identified
as being at risk
- Complete reflective template

36. Based on social movement theory and
body of evidence

37. Developing your key messages into an
engaging narrative that is bespoke to each
audience can help to really enthuse
others

38. It can really help to view those involved in
improvement work with you as
volunteers….focuses the mind on how to
truly engage

39. We need to develop multiple key
messages (adapted stories) for our
different audiences to truly
- Engage and connect
- Energise behind change
- Share authentically
- Engineer commitment first before we
use compliance

40. Consider how you would describe the changes to ….
 a locum GP joining the practice
 a friend at the school gate
 a patient
 a carer / family member for an elderly relative
 a neighbour

41. Strengthen your narrative by
using vivid details and real life
examples

43. How do you make this happen
• There are well established rules to help develop your
narrative
• Authenticity is crucial
• Adapt your story
• Practice, Practice, Practice!

44. Measurement
0
100
200
300
400
500
600
2011-14
2011-20
2011-26
2011-32
2011-38
2011-44
2011-50
2012-3
2012-9
2012-15
2012-21
2012-27
2012-33
2012-39
2012-45
2012-51
2013-4
2013-10
2013-16
2013-22
2013-28
2013-34
2013-40
2013-46
2013-52
2014-5
Weekly Attenders
Data Average ULC LCL

46. The traditions of measurement
• eg A-B comparison, average, huge dataset
Research
• eg one-to-many benchmarking
comparison, average, large dataset
Judgement
• eg continual analysis of single changing
process over time
Improvement

47. How do you look at your data ?

48. % of patients with 3 key processes complete

49. How do you make this happen?
• Choose what you measure carefully
• Link to shared purpose and system drivers
• Measure often
• Think about how displaying your data will engage staff
and service users

50. Creative thinking

52. 1st & 2nd Order Change
Incremental Improvement
1st Order change
Is good and required
Transformation
2nd Order change
Is good and required

53. Healthcare example
“McJab - Do you want fries with that…?”

54. 1st & 2nd Order Change
Incremental Improvement
1st Order change
Is good and required
Transformation
2nd Order change
Is good and required
If we did both – simultaneously – the
results would be amazing?

55. Rules for idea generation
 Criticism is ruled out
 Encourage wild ideas
 Build on the ideas of others
 Promote equality of contribution
 Answers not just from leaders
 Go for quantity to avoid ‘silver bullet’ thinking
 Think about conducive environment to create
transformational space

56. Structured
Thinking

57. How do you make this happen?
• It’s ok (and good!) not to have all the answers
• Tools and structure c an be used to help ideas
creation
• Create space and time to allow frontline staff to
innovate
• Leaders can help by providing the ‘air cover’
• Allow experimentation

58. WHY?
Real lasting change across the system occurs
when we utilise core improvement principles in
all areas that are adapted for each setting.
Quality improvement is the way to deliver true
high quality care with the least amount of
resources.

59. WHAT?
Flexibly supporting local systems to deliver
their change by focusing on work with
senior leaders, management and frontline
staff across the whole system.

60. HOW?
Shared
purpose
Narrative
Measurement Creative
thinking

62. Our emails:
tommargham@nhs.net
mani.dhesi@nhsiq.nhs.uk
youtube.com/c/transformingcare
Our YouTube channel packed with online
webinars (measurement, capacity & demand etc),
team videos/case studies and Productive General
Practice resources
NHSIQ.nhs.uk
Go to the Transforming Care
team pages for tools and
resources.
Twitter:
@TransformCare