A whole system approach to clinical commissioning

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What are the challenges of leading change across a local health economy? We spoke to some Hertfordshire GPs and found out how the support and constructive challenge they received as part of The King's Fund's Whole System Leadership programme has been 'absolutely essential' in enabling them to drive through service redesign.

Meeting the QIPP agenda

Like many local health economies, Hertfordshire faces considerable challenges trying to improve services and meet the QIPP agenda with limited resources.

Heart failure care has been particularly challenging. Too often patients are discharged with their medications, struggle with their health at home, become unwell and repeatedly end up back in hospital for costly and protracted stays.

Patients need better long-term support but, says Dr Anita Goraya, PPC Lead, Diabetes Services, East and North Hertfordshire, previous 'tweaks' to primary or acute care have failed to fully meet their needs. 'There's been nothing comprehensive or whole system,' she explains. 'There's been no community-based heart failure system in my patch at all.'

Working collaboratively

But that might be about to change. Dr Goraya and several GP colleagues have got together with a view to achieving better long-term results. They are learning how to analyse service challenges as a team in order to deliver integrated care.

Another group of Hertfordshire GPs is looking to improve end-of-life care for patients with dementia. 'It is about ensuring that people get appropriate end-of-life care in the right environment while being fully supported,' says Dr Peter Graves, Chief Executive of Bedfordshire and Hertfordshire Local Medical Committee Ltd. 'It's about ensuring the right questions have been asked, by the right people, including the patients, and that all the information is readily available for whichever clinician or professional walks through the door.'

A fresh approach to delivering care

'We're looking to try and develop a patient-oriented service right the way through from before someone makes an appointment to when they finish an episode of treatment,' says Peter. This means, he says, developing GPs' confidence and capability to get everyone on board and make sure projects come to fruition.

A dozen Hertfordshire GPs have joined our Whole System Leadership programme, with the aim of improving their leadership skills and learning how to build relationships, influence and negotiate with key colleagues from different sectors.

Creating the right climate for change

Leadership development is not just about technical competencies, but also the ability to create climates in which individuals can improve services and care, so the GPs are also learning how to set the direction for multiple stakeholders, build common ground and reach agreement based on evaluating clinical, organisational and financial data and balancing risks.

Programme director, Liz Thiebe, says a distinguishing feature of the programme is how it tackles real-life issues facing local health economies. 'GPs tend not to like being put in a room and lectured at, they want to do something.' she says. 'They're also very skilled at having one-to-one conversations with patients, and want to learn how to translate this skill to influence a wider audience.'

Developing individuals and groups

Anita says the programme has helped with more than just project management. 'We've learned about body language, presentation and relationship-building skills. You're networking with people who are in positions to work with you and co-operate with you in the future.'

The programme has, says Peter, already helped GPs to present their ideas for heart failure care to different stakeholders, including hospital clinicians, and will further help them develop a formal business case to support service redesign. He believes this programme has been 'absolutely essential' to the development of both care projects. 'We are constantly challenged in a constructive way and receive support at crucial moments.'

Developing future leaders

The King's Fund's Commission on Leadership and Management in the NHS reported, 'Commissioning consortia will need skilled leaders but they will also require a much larger number of willing and committed followers if they are to fulfill their functions effectively.' Peter expects some colleagues on the programme will go on to take up leadership roles with new commissioning consortia.

Anita says that there are others, like her, who may not want to be consortia leads, but still aim to play their part on commissioning and improving services, using what they've learned on the programme.

This article first appeared in Insight, a magazine produced by The King's Fund for the NHS Confederation Conference 2012.


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