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The innovations challenge to Primary Care – Dr Robert Varnam

The Five Year Forward View recognises the vital role which primary care plays at the heart of the NHS.

It also outlines the need for improvement and innovation, including an ambition to improve access and deliver care which is more personalised, proactive and coordinated.

It’s therefore a privilege to be supporting the 20 pilots in the Prime Minister’s Challenge fund who are testing innovations in access and care, and exciting to be looking ahead to a second phase of the programme next year.

As a GP I’ve always been passionate about access in primary care. A few years ago our practice started using GP phone consultations as the first point of contact for patients seeking help.

Mid-morning on the first day, a rather frantic Friday, I had a call with a lady in her late sixties who had rung intending to ask for a non-urgent appointment at the surgery. She had expected something of a negotiation with the receptionist, and to have to wait three or four days, and so was surprised to be told the GP would ring back shortly. I spoke to her about 10 minutes after she had called.

Having reassured her that she wasn’t ‘mithering’ me, I listened to her symptoms, and surmised she was probably having a heart attack.

Later that afternoon, she was in the cardiac cath lab having multiple stents put in her heart. She lived to tell the tale – and to thank me for having dealt with her much quicker than she’d thought necessary. But without us having made an effort to improve our access, it’s quite likely she would have died, alone in her first floor flat, waiting for her appointment at the surgery.

Responsive, flexible access is an essential part of a good patient experience, and a central part of our ability to provide safe, effective and efficient care. I don’t believe there’s much point in having great people providing great care if it’s too hard or slow for patients to get access to it. Similarly, it’s hard to see the value in quick or easy access to poor or inappropriate care.

The challenge for primary care is to develop spreadable innovations which meet rising demand, growing complexity and increasing diversity of patient need, through simultaneously improving access AND the care which is accessed. We want to provide the right kind of access to the right kind of care, acknowledging that one size does not fit all. That’s why I’m so pleased to be supporting both the first and second waves of Challenge Fund pilots as they test their innovations.

The first wave of the Challenge Fund has already produced some important learning. Perhaps the most encouraging is that general practice is ready and willing to contribute to new ways of improving care and outcomes.

I don’t think anyone expected we would receive over 250 expressions of interest covering two thirds of the population of England. Also encouraging was the comprehensiveness of vision being pursued by applicants, with practices proposing to work together in new ways to offer significantly enhanced care for their patients.

Primary care has demonstrated that it is ready to step up to the plate if given the headroom to innovate.

Our national evaluation will generate in-depth learning about how these innovations perform, and what the conditions are for successful adoption of them. We’re confident that this will provide a valuable resource for providers and commissioners throughout England.

However, the first wave of the Challenge Fund has already begun to provide helpful insights which we will use to support pilots in wave two. Through our innovation support programme, which maintains close relationships with the pilot teams, we are learning valuable lessons about the success factors for planning and leading innovation across groups of GP practices. We intend to turn this into actionable learning for practices planning to apply for wave two, as well as for the wider NHS.

Some of the earliest lessons have been about the value of leaders engaging with participating practices and local patients at every stage of the change programme. Pilots who have created the most engaged approach have reaped benefits early on. Treating colleagues and patients as collaborators has enabled them to design better solutions, iron out problems quickly, maintain staff enthusiasm and recruit patients as partners and champions.

One of the most effective ways to create and maintain momentum through this kind of engagement seems to be bringing together staff and patients, to describe what they want the future of care to look like.

Sharing aspirations like this helps to uncover common values and build a shared purpose for change, which is a great foundation for success. We’re particularly grateful to NHS Improving Quality’s primary care team for supporting and coaching pilots in the practicalities of developing great change strategies for the Challenge Fund.

Over coming weeks, I’ll share more emerging lessons about the ‘How’ of primary care innovation through this blog.

For practices considering an application for wave two, we’re also holding a series of webinars presenting more detailed tips. I hope you’re able to join us – full details are here – Invitation to be part of the second cohort of innovative practices improving access to patients in England.


Dr Robert Varnam PhD MSc MRCGP is the Head of General Practice Development at NHS EnglandDr Robert Varnam PhD MSc MRCGP is the Head of General Practice Development at NHS England and a GP in a large inner city practice in Rusholme, Manchester.

Robert has been involved in leading service improvement and clinical governance within his practice, in the local area and nationally. He previously held roles in the PCT and practice based commissioning group, and was clinical lead for practice accreditation at the Royal College of General Practitioners.

His research work at the University of Manchester covered both epidemiological and sociological approaches to understanding quality and patient safety in primary care. He was involved in introducing new research governance procedures at the National Primary Care Research and Development Centre.

At the NHS Institute for Innovation and Improvement, Robert was involved in the establishment of novel development programmes for primary care staff, to build practices’ ability to improve safety, quality and productivity.

Robert co-chaired the NHS Future Forum’s work on integrated care. He has been involved in the development of clinically led commissioning, including frameworks for authorising and supporting CCGs. He helped to establish the Royal College of GPs’ Centre for Commissioning and the NHS Institute’s development programmes for CCGs, and created NHS Improving Quality’s transformational change programme. He has provided advice on large scale change for policymakers and healthcare leaders from Birmingham to British Columbia.

Robert joined NHS England in 2013, with responsibility for developing policies and programmes to promote, support and sustain innovation and improvement in general practice. His aim is to make it easier for practices to make care more proactive and coordinated, holistic and person-centred, with fast and responsive access, effective health promotion and consistently high quality.

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One comment

  1. Terence Singleton says:

    Dr Varnam It is most encouraging to find at last, within this vast range of innovation information, the person who seeks to help the primary care innovator.
    we have developed, with the help of a spinal surgeon, a system of lower back pain relief, for both acute and chronic with/without referred pain. Nice have requested case study and we are to meet through AHSN/Nexus business managers in early Jan, the innovation is such to be applied in primary care by your practice Nurse, after training, or the team Nurse we would supply. Five volunteers were totally pain free in one 45 minute session. a remarkable breakthrough.