We're a primary care network - now what?

@robertvarnam #NHSLongTermPlan@robertvarnam #NHSLongTermPlan
We’re a PCN … now what?
Dr Robert Varnam PhD MRCGP MSc
Director of Professional Leadership for Improvement
Improvement Directorate
NHS England and NHS Improvement
@robertvarnam
bit.ly/190529moulton

@robertvarnam #NHSLongTermPlan
So much to talk about!
What’s taken most of your time…
• Memorandum of understanding?
• Decision making structures?
• Voting rights?
• DES payments?
• Distribution of payments?
• Voting rights?
• Liabilities?
• Pharmacist contracts?
• Social prescribing link worker contracts?
• Opening hours for access schemes?
• Next year's Network Services?
• etc
• etc …

What have we learned?
Common pitfalls:
• Start with structure and governance
• Not releasing clinician time
• Insufficient investment in leadership development
• Lack of systematic approach to improvement

Building a successful network…
Purpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > formPurpose > function > form

 Agree what matters & where you’re going
 Pick something to achieve
 Do it together
 Build relationships, capabilities & structures as
you go
So …?

Where are you heading?
Why does it matter to you?

Continuity Accessible personal
care built on a relationship from cradle
to grave
Community focussed Responsible for
a registered population, improving wellbeing
Holistic Dealing with the patient as a
person not a disease or part of the body
Comprehensive Handling wide range
of problems, managing clinical uncertainty
STRENGTHS OF PRIMARY CARE
Central Coordinating and connecting
other teams, referring where appropriate

Continuity
Community focussed
Holistic
Comprehensive
STRENGTHS OF PRIMARY CARE
Central
BUT …
Demand >> workforce
Practices are set up to provide
mostly medical care (reactive,
individual > proactive, population
focused)
Most lack collaborative
relationships required to truly be
central to patients’ care
Too small and isolated to have
significant impact on population or
system

GENERAL PRACTICE
FORWARD VIEW 10 High Impact Actions
Innovations from around England
that release time for GPs to do
more of what only they can do.
bit.ly/gpcapacityforum

Innovations from practices
throughout around England that
release time and improve care.
GENERAL PRACTICE

Your own Time for Care programme
bit.ly/T4Cmay2019

Building a successful network…
Purpose > function > form
Where are you heading?
Why does it matter to you?

Your leadership development
Dr Robert Varnam PhD MRCGP MSc
Director of Professional Leadership for Improvement
Improvement Directorate
NHS England and NHS Improvement
@robertvarnam

Experience so far…
Development priorities
Very wide-ranging roles. Traditional focus has a place (leader as rep / manager). But
2 major new priorities:
• Leading across boundaries, creating vision & shared purpose, building ‘new
power’ partnerships
• Leading service redesign and improvement
Development ‘offers’
Need to be tailored to primary care needs & context. Currently some significant
capacity gaps.
Share – learn – do – grow
• Peer-to-peer sharing of challenges, solutions and support
• Learn perspectives, tools & skills to support your work
• Continuous cycle of implementation and learning
• Deliberate approach to personal growth and resilience
Leadership development and primary care.
Tim Swanwick, Robert Varnam. dx.doi.org/10.1136/leader-2019-000145

Your leadership development
Governance
Providing safe and effective oversight of
financial and clinical matters
Community of Practice
A local community of leaders, connecting regularly to share ideas, learn together and provide mutual support as
they lead change. Typically a community of practice will include all the PCN leaders across an ICS/STP, and be
supported by an expert facilitator. Many PCN leaders will also be part of other communities of practice.
Growing as a leader
Realising your personal development needs
as part of a supportive and stimulating peer-
led community.
Developing your style
Understanding the range of leadership
styles, and planning to develop your own
strengths.
Resilience
Planning and support to be maintain your
wellbeing and effectiveness.
Leading improvement
Creating the culture and capabilities for
continuous improvement in the safety,
effectiveness and experience of care.
Leading across boundaries
Creating vision and shared purpose,
developing trust and a movement for change
that inspires commitment.
Leading teams
Promoting compassionate and high quality
team cultures, supporting staff and
overseeing talent management.
Service design
Leading redesign and the creation of new
services and pathways using the best of
design principles.
Leading within a system
Thinking, planning and prioritising
strategically, and building organisational
partnerships for change.
Population health management
Understanding the needs of the registered
population and developing services to meet
specific needs more proactively.
Workforce development
Designing new ways of working, introducing
new roles. Developing skills and creating
more flexible careers.
Time for care
Rapid improvement collaboratives to release
clinical capacity and improve access using the
10 High Impact Actions.
New models of care
Building partnerships with the community
and other providers, adapting successful
models from elsewhere, sharing and shifting
resources.
Developing analytics
Establishing systems and capability to analyse
population needs, service activity and
outcomes.
Partnering with communities
Collaborating with local people to build the
assets the community and individuals to
improve wellbeing.
FoundationsSpecialtopicsTeamtopics

A few suggestions
Share
• BMA Clinical Directors network
• RCGP GP At Scale
• National CDs WhatsApp group - chat.whatsapp.com/Ld9Pb1HuB75DszdX128U5j
Reflect
• www.leadershipacademy.nhs.uk/resources/healthcare-leadership-model/supporting-
tools-resources/healthcare-leadership-model-self-assessment-tool/
• Clifton Strength Finder
• Thomas-Killman conflict inventory
Learn
• NHS Leadership Academy
• “Developing outstanding leadership in primary care”
• www.leadershipeastmidlands.nhs.uk/coaching
• General Practice Improvement Leaders programme
• Leading Transformation in Primary Care (robert.varnam@nhs.net)
Support
• NHS Collaborate
Succession planning
• Next Generation GP

We're a primary care network - now what?

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