In his third guest blog, management consultant Scott McKenzie examines the potential reasons for forming a larger hub or GP federation before you make the change and the importance of the leadership role in making the at scale model deliver the benefits you envisaged.
The short answer to the question in the title is no. It is not guaranteed that merging, forming a hub of 30,000 to 50,000 patients or developing a GP federation will equal better.
Scott Mckenzie
Independent Management Consultant
“Five frogs are sitting on a log. Four decide to jump off. How many are left? Five, because deciding is different than doing” – Anonymous
The key to developing any at scale model, is what you plan to do via the model that you cannot do now. All too often I see people forming an at scale model, but then continuing to do exactly what they were before forming. In that instance, bigger is unlikely to equal better.
You need a vision for why you want to come together. You also need dynamic leadership that is visible and prepared to be accountable. You might therefore want to consider what wouldn’t happen if you didn’t come together at scale? What challenges would you face alone that you may find easier to tackle with greater scale?
From my own work I usually find some or all the following things on the list:
- Recruitment and retention of healthcare professionals
- Workload and demand, which includes the levels of unfunded work
- The ongoing pay freeze; can we drive efficiency by operating at scale
- Financial stability (or instability)
- Care Quality Commission (CQC); can we have one set of policies and procedures?
- Indemnity fees (rising)
- Phasing out of Minimum Practice Income Guarantee (MPIG)
- Seven-day opening
- Desire to collaborate with other providers; possibility of subcontracting from hospital
- Represent General Practice with one voice
- Recruit and deploy new roles in to General Practice and/or Primary Care
- Introduction of new services
- Ability to deliver one high quality standardised approach without unwarranted variation
There will be local items that make your list, which is exactly how it should be.
If you cannot clearly articulate the why you are coming together and what you aim to achieve I urge you to stop and find those answers before you do anything further.
What is clear to me is that you must have an element of being likeminded at the start. You then start working together and continue to build trust. One of the best ways of doing that is to start with the projects that are directly in your control and do not need approval from anyone other than the member practices e.g. standardising your approach to personally administered items, running a vaccination programme (you can tackle preventing avoidable non elective admissions to hospital), consumables and developing a staff bank, which includes all roles in General Practice.
This quickly leads to all involved seeing the benefits of the at scale model.
This is the first step and should come before you sort out the form of your at scale provider.
These basic service changes provide a platform to move forward. It is a well-worn route in my work that has resulted in people selecting the right model for the outcomes they want to achieve. Beyond formation, these entities work in collaboration with the CCG (direct contracts) and/or hospital trust (subcontracts). The at scale provider that can deliver one high quality standardised approach without unwarranted variation where equipment, pathways referral points and drugs are all specified, readily becomes attractive as a provider. I can demonstrate this easily for anyone using live examples within my work. I have many examples where this approach has been taken, resulting in rapid growth for the at scale model.
In this instance, the answer to the question is yes, bigger is likely to equal better. You will be building sustainability and resilience in to the practices.
I believe that you can only get better results by being prepared to think and act differently; by seeing through the changes you agree, and by ensuring the important things get measured. Where any measurement comes up short of what is expected, you then need to act upon what you find.
As prominent NHS blogger Roy Lilley often says “Great leaders are visible, have a vision and share it often. They create the time and space for good people to do great things”. Absolutely what’s required as you start to operate at scale.
In my next blog, we will pick up what you can do if you have already formed a federation and the outcomes are not what you planned or envisaged.
The PMA offer two workshops supporting working at scale. New Models of Care – delivering change and New Models of Care – strategy & planning
