Thoughts after PCN Plus

I retired 3.5 years ago from General practice. With hindsight I had some senior leadership positions though when I was in them I did not think of them as this. I was an accidental leader, ended up in roles without seeking them. They found me. I am not saying this is a good or a bad thing. I just tried to do the best I could for those around me, encouraged the next layer of leaders to come on board as I never really thought I was good enough. But also to have a safe exit when they found out I was no good or I became ill.

I was at PCN Plus LIVE - Life Beyond the PCN DES (ringcentral.com) yesterday.

The GP leaders there were more confident than me, I think. That is a good thing.

But it was like ground hog day. I was looking forward to the amazing progress since I retired, and there has been. But same issues. With hind sight I should not have been surprised.

Relationships matter. Those who have strong relationships backing up a strong mission and strategy are doing ok.

Those with stressed relationships are...........stressed. With funding flatlining and inflation rocketing there is less cash to go around. Strong teams adapt to this.

They can take the longer view. General practice is needed. Without General practice there is no NHS.

Modern general practice is evolving into a data driven, population health management organisation of a "place".

Demand is rising due to aging population and a population that is way less resilient due to pandemic of metabolic ill-health (Boom for pharma industry!),

and rising mental ill health driven by lockdown (unnatural few years where we lost real connection with people) and poor metabolic health driving the inflamed brain and the effects that has on us.

So understanding the demand is critical, and it is not because one person may be perceived to be not pulling their weight. But when teams get stressed sometimes fingers are pointed rather than understand root cause.

Understanding who is coming through the front door, why and what co-morbidities they have are critical. In "place" it is understanding their context- financial, housing, purpose and connection with other humans (and animals- dogs are wonderful!). We used to call this "holistic care".

Then efficiencies- right person first time for who ever turns up. This requires good triage. Digital is easier. Then you reduce duplication. Mental health crisis with health coach will not work, even if there are no other appointments.

Then understanding what can be prevented. Working with other stakeholders can improve connections with people and make an environment less toxic. By this I mean planning for fast food outlets, green areas for time in nature and movement. The solution to the hospital lies outside the hospital- make friends and they will help you.

Improving population health has more to do with employment, housing, education, real connection with people, food, sleep and and activity.

Sadly my expertise in prescribing for symptoms of disease does not prevent.

One of our first project proved the impact of real food on a population that standard care had little more to offer. They were on max meds, and people were hoarse from saying eat less move more!.

https://controldtx.com/outcomes/homewell-practice-study/

Salutogenesis is a real option, though no official incentives are there to encourage people to invest in this area.

Your key resource in primary care is people. Invest time in them National Association of Primary Care (NAPC) are great people to help develop teams. (Conflict of interest- I am a council member). Or use whoever you trust to have protected time to think. Yes this will cost, but returns will be more than the cost.

Let as many as you can contribute to your strategy then all will feel ownership and more likely to buy in.

Then implementation has to happen. If you have the doers in your team give them permission to deliver the bits they like most or have skills in. If not- buy in project managers.

The worst thing is to do nothing.

Those who survive are not the brightest or wisest, but those who are most adaptable. Be the humble adaptable leader and people will joyfully follow you.

Look beyond the pain/pressure of the next year. If you are in a better place after the election when more investment will come, then you can grow quicker and better than those who languish in pain and sometimes self pity.

This is a great time to be involved in an organisation that can truly deliver amazing outcomes for your patients.

Dont wait for NHSE- they dont know. You are the expert in your place.

Measurable outcomes- staff happiness, patient satisfaction, outcomes (for me- increasing the number of patients in T2DM remission, and preventing the growth in new T2DM diagnosis). and increase in profitability (do not be ashamed of running a good business).