Jonathan Serjeant: How to empower primary care to innovate and accelerate the uptake of new models of care

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  • Posted:Tuesday 18 October 2016

Dr Jonathan Serjeant, Co-founder and Clinical Director, Brighton and Hove Integrated Care, shares lessons from NHS Collaborate on how to support leaders to create the right conditions to test, share and learn.

This presentation was filmed at our conference, Emerging models of primary care, on 18 October 2016.


How do we look after you as leaders, to actually deliver some of the changes essential over the next five, ten, fifteen years?

I’m going to talk to you about a programme called NHS Collaborate, and it’s an initiative to support our determined and capable primary care leaders to help transform teams and accelerate the delivery of new models of care. We’ve identified, established and emerging leaders from around the country and what we’ve done is we’ve tried to focus on the human journey of leadership, and through this we’ve seeded the social architecture of our collaborate community through listening.

So we gathered a small network of people together. We had a day together, about fourteen of us, and we did something called generative listening. It requires you to listen without interrupting both verbally and non-verbally.  And we also developed a community of practise, and there’s three principals.

You first see and create the social architecture, which is for the people around issues. And then you nurture and you look after the knowledge and the content of that social architecture, discuss it, and then you provide a technical architecture which enables those virtual platform, for people to connect and stay in touch with each other.

We engaged with primary and community leaders and we recorded these conversations with their permission, and then we transcribed them and then we analysed them. We looked for patterns and issues and then we listened again.

So what do we hear? And what did we learn? Well we heard a lot about making a difference, a lot about people’s connection to vision and the real importance of communication. We also heard particular dissatisfaction with current leadership programmes, which can be based very process driven and lack emotional support.

Leaders and emergent leaders in primary care are asking for a support mechanism that is long term to enable and equip them to manage the inevitable future change, and not just a two year mentorship programme.

One of my common observations in having these conversations with people, is we would do them in groups. Two, threes or fours of leaders who have known each other for five, ten years. We discovered that they don’t know each other at all.  They don’t spend time to understand their behaviours and when you give them the space to do that, you find people actually connect and that feeling of isolation, which is felt by most, subsides.

There was also issues that have come up. There’s a tension between local support and national support. What we discovered was that many people see national recognition as sort of hubristic and counterproductive.  People have struggled with innovation as a lever for change and then trying to scale that at pace, and GPs whilst still recognising that they need to work in partnership with other kind of professionals, struggle to let go of what they’re doing professionally, and there’s people who are open to sort of new forms of communications like Twitter or social media or WhatsApp for example, but actually many are finding the time just to get their head out of the water.

And I think one of the key things is around failure and success is, that success is currently measured in the context of a system that is dominated by secondary care, and if we’re going to transform the system, we need to find some new measure of success.

This is my favourite quote, which is there’s a natural vulnerability amongst us. In fact one of the people that’s inside me talking about leadership, talked about the power of vulnerability and I think there was something about leaders learning to be vulnerable with one another. And when we interviewed two to four colleagues together, and we helped them talk openly about their personal vulnerability, they left, all of them left with a different feeling of connection with their colleagues.

It quickly became evident that its future purpose is to connect primary care leaders at a human and personal level. Enabling them to understand each other’s journey of leadership. To build confidence and take risk towards transforming care and to establish a new authority for primary care.

So phase 2 of Collaborate, is as a sort of self-shaping and evolving multidisciplinary community. Its future and its outcomes are quite difficult to articulate because it’s quite an organic process. However, we are very clear this is not about developing a programme for 40 leaders.  It’s about planting a tree and providing a platform that will grow organically, supported in its early phase and be very self-sustaining for its future.

The perfect outcome, after three years of this programme from now, would be for every senior leader within at-scale providers to no longer feel alone, and during that journey we need to continue to look after each other.

You can connect to our micro-site which is NHS Collaborate. There’s a report of what we’ve done which you can download from that site, and thank you for your time.


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