In his latest guest blog, management consultant Scott McKenzie examines what it takes to become a successful federation and what you need to do, if after a time, you are not progressing as planned.
Whether newly set up or long established, if your federation hasn’t fully realised the benefits of federated working, it’s never too late to get back to basics around why you formed and build a viable, sustainable and resilient GP federation.
Scott Mckenzie
Independent Management Consultant
Joint vision
When you originally came together you should have had a vision for why you wanted to come together? If you didn’t have that and cannot clearly articulate the why you are came together, I urge you to stop and find those answers before you do anything further.
If that vision is there, start with a review of what you have done to date? What went well and as expected, what went less well or didn’t go as planned at all – why was that?
First and foremost, what is your relationship like with your Member Practices (shareholders)? If you asked them for a view on the GP federation what would it be? Would it be positive or negative? Why? Would they remember they are Members of the Federation and who sits on the Board of Directors?
Business planning
Did you develop a business plan and then either didn’t implement it or were you distracted by another project or idea? What stopped you from doing as you planned?
“The most critical thing I think business leaders and future business leaders need to understand is to stay focused on the things that you can control and influence, and then execute, execute, execute.” John Chambers, Cisco CEO
Delivering success
To deliver success as a federation requires a new way of working. It is a cultural change, as the Member Practice must concede decision making power to the Board of Directors, which is often a challenge. For me the members are either all the way in, or all the way out. What you cannot have is people engaging and disengaging when they feel like it. They own the company and need to support it, or hold the Board accountable, which can be done with a little as 5% of the voting shares. This therefore requires a leadership epidemic across the Membership. Leadership is not an elite sport for the Board of Directors but rather a participant sport for all Members.
I therefore advocate you don’t do anything top down, but rather take time to engage front line upwards. I can assure you there is nothing to fear in engaging everyone affected by the proposed change/project, right at the start, and indeed, everything to gain. Whilst challenging, this ensures that the vision created is one that has been developed by all those who have a role to play, whatever that role, leading to buy-in and ownership of what you create as a “community for change”, bringing about a critical mass for driving successful change.
The fundamentals
This is the fundamental basis I work from when it comes to my work with any group. Everyone is involved in the development of the vision. They then own the problem and the creation of the solution, meaning you will then see people implementing what they own and develop.
Practice Engagement is therefore THE key ingredient. Without it you are destined to fail.
If you look back at my last blog, this is where the projects that are in your own control are ideal. These ideas 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.
Implementing these quickly leads to all involved seeing the benefits of the at scale model.
Implementation
From that point onwards, you have evidence that you can implement projects with one high quality and standardised approach and without unwarranted variation. This provides a platform to then engage with your health economy partners;
- CCG
- Foundation or Hospital Trust
- Community Services
- Local Authority
- Others
In my work using that process as our platform to engage the health economy partners has worked well. It has led to CCGs directly commissioning services and significant subcontracts from secondary care, even those who are in turnaround have subcontracted. All on the basis that the federation has been able to demonstrate the practices are all engaged working with or supporting their Board of Directors. There is nothing better than a demonstrable track record of delivery.
If you want examples of what has been achieved, please contact us and we’ll be happy to share what has worked for others:
- Directly commissioned
- Subcontracted
- Examples from other Federations
- Developing Gain Share
- Tackling unwarranted and unexplained variation.
