Coastal West Sussex

GP Commissioning in Coastal West Sussex: Leadership, Educational Philosophy & Practice

Jim Price, GP Chichester, Educational Adviser to Coastal West Sussex

Two basic rules of life are:
1) Change is inevitable and
2) Everybody resists change’.
W. Edwards Deming (1900 – 1993) Quality Guru

GP Commissioning: the new world

So what is all this GP commissioning stuff about? Haven’t we seen it all before? Isn’t it just another huge organisational change causing chaos in the NHS for the sake of it? Isn’t it just so a new government and Health Minister can make their mark? Isn’t it just a return to Fundholding consortia or PCGs? Isn’t this just the same old wheel being reinvented yet again?

I’m sure many of my senior colleagues, who might perhaps describe themselves as ‘experienced & wise’, if not plain cynical, might also be forgiven for thinking in this way. When the new policy was first announced, I must admit some of these thoughts ran through my own mind. However, having reflected on things for a while now, I really do think this new model might just work. If we get the structures (and more importantly the relationships and leadership) right, I genuinely feel that these new changes could empower general practice and primary care to make the changes needed to improve the efficiency and reduce waste in the NHS (one of the biggest challenges we face), whilst also offering us the opportunity to redesign and improve our own working practices and conditions.
Please excuse this brief sojourn for a moment, but history and context can often be very important. Some of you with grey hair will remember that in 1996 or thereabouts, we had formed something called the ‘Chichester Fundholding Consortium’, a rudimentary commissioning group, and of which I happened to be Chairman. Despite a lot of game-playing with the ‘wily foxes’ at the Acute trust, we did actually begin to make significant changes in clinical services which were carried forward into the Primary Care Groups post 1997, and the smaller Primary Care Trust arrangements (2002-6). In fact ‘Western Sussex PCT’ was beginning to prove itself to be a very successful, supportive and inclusive organisation just as it was ‘put to the sword’ by the (predictably) unpopular and unsuccessful changes of 2006. When that original smaller PCT came into existence, I remember discussing that one of the principal measures of its success would be when practices, GPs and others in primary care felt as if we ourselves were part of the PCT, that it was ‘our’ organisation, rather than the “us (the practices) and them (the PCT)” relationship which has developed over recent years. Indeed we very nearly got to that point by 2006, and I believe that many people felt that at that point “we all were the PCT”. I think there are several things we can learn from the development of that organisation, one of which is about getting involved.

Getting Involved
‘We must become the change we want to see in the world’
Mahatma Gandhi (1869 – 1948) Indian Nationalist Leader

Gandhi’s words are very apt as we approach these new GP commissioning organisational structures. In reality there is no alternative for us – the Health Bill will be published when you read this, and all these changes will be on the statute book very soon. From a theoretical point of view the National Commissioning Board will relate directly to our Consortium / Federation and resources and power will be with us and the locality groups very soon indeed. There are going to be increasingly important opportunities for engagement at a local level, and, although I know much good work has already gone on, engagement in clinical and other projects will become ever more important, and indeed in time, an accepted part of many people’s day jobs. We have top quality people here in West Sussex with the enthusiasm to change things for the better and improve services for patients, and these people all need to get involved in small scale improvement projects. If they do and we are successful in these improvement projects, it is very likely to lead to increased job satisfaction for both those directly involved as well as the wider health community, clinicians and non-clinicians alike, in primary and secondary care. In short, we all need to get involved!

Where are we going?
None of us really likes uncertainty, although we have to deal with it in clinical practice every day, but in organisational terms these new commissioning arrangements really do give us all a chance to shape the future. I think Peter Drucker got it right when he said: ‘ The best way to predict the future is to create it.’ I think we can and should all get involved and create our future, even if time pressures mean it is only a small part of our professional portfolio. Exactly where we go will depend on the leaders who emerge, and the vision they jointly develop with others. Whatever that vision, we are in an excellent position to achieve it, since we have a lot of good people around, and good people are what will make this thing work.

Good people
In West Sussex there are many high quality professionals, in both clinical and social & caring services, who are dedicated to fulfilling these professional roles to the best of their ability on behalf of patients and clients. There are also many good managers who support the clinicians, and the changes should allow us to take the best of these along with us into the new organisational structures. We also have extremely motivated and able patients, whom I know will want to get involved; in fact we will really need them! There is no doubt that we will face some difficult rationing decisions very soon, and we will need the engagement of informed patients and patient groups, since they will be instrumental in informing and supporting these very difficult decisions in what will be a very cold and uncomfortable financial and political climate.

Relational leadership and educational support
However we should return to the sunnier prospect of the new dawn of GP Commissioning. These changes offer us the potential to develop a new set of relationships in health and social care, based on openly agreed values and ethical principles, which will genuinely offer power and responsibility to primary care organisations and patients.
It will take strong leadership, at every level, on the Federation board, in the localities, in the Trusts, in the community services provider, at the practice cluster level, in clinical pathway task and finish groups, and indeed within every general practice. We will need to build strong relationships between practices, clusters and localities, and indeed between commissioning consortia on the larger scale. These relationships will need to be nurtured both socially and professionally, and educational and organisational development programmes offer one of the principal spaces in which these relationships can be encouraged to flourish.

In this newsletter and at the event on the 19th January, the new ENCIRCLE protected learning time scheme for primary care will be described, and we will also be developing support mechanisms for both individuals and groups through an educational Masterclass Programme, supported by personal coaching and mentoring, as well as group/team development when needed. The development of a ‘learning network’ for commissioning development is planned, and will be co-designed by the commissioning organisations, such as Coastal West Sussex, with the KSS Deanery and the Institute of Postgraduate Medicine at Brighton, who will act as an educational an facilitative hub in the network. Further details of the programme will be available soon. The philosophy will be to support individuals and teams in a flexible way, with high quality, and potentially accreditable, educational courses and events, coupled to bespoke individual professional development advice and support. It should be a lot of fun!

Closing the Circle: let’s end with the beginnings of a Commissioning Roar!
So back to the question of whether this “commissioning stuff” is just the same old wheel being reinvented yet again… I guess the truth is that it could be; however I am convinced that together we do have a unique opportunity to ensure that this will not be the case. I believe we can all be the future we dream of – it just means that we all need to show our commitment to what should be ‘our’ organisation, and ‘our’ local health service. Perhaps it might be appropriate to view it through the eyes of a ‘Clinical Lion King’ (…apologies!). Things do come round again in cycles, but so much has changed in the 15 years since Fundholding Consortium days: there are many new ways of doing things and many young and talented leaders at every level, in every practice and in every service. Each of us needs be true to our values and commit, not to reinventing the wheel, but to engaging in this ‘Circle of NHS Life’. We need to do this in a way which is individually appropriate for our experience, clinical interests and time, yet we must all offer that commitment in a refreshed, re-invigorated and enthusiastic way. I don’t think we yet need a ‘Primal Scream’ for our NHS neuroses, but we do need to begin the New Year and new Federation all together, in unison if possible, and perhaps, as the circle begins again, with a loud, leonine Commissioning ROAR… virtual or real… it’s up to you!