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Dancing at the edge of authority

The Director of the New Care Models Programme talks about the growing relationship with the Medical Royal Colleges to explore new ideas for health care:

The New Care Models programme is working with the Academy of Medical Royal Colleges (AoMRC) to build stronger clinical engagement and leadership.

It is essential we work together on innovations to improve the capacity and capability of our healthcare professions, looking particularly at new forms of teamwork and collaboration.

This month, the Royal Colleges and NHS England came together for an event that looked at successful teambuilding across traditional divides, the impact on patients and the benefits for frontline professionals.

At one point, we heard about Stockport Together vanguard’s hotline to consultants, making it faster for GPs to consult specialists.  Contact with a consultant has reduced the need for a hospital referral and often means a patient can leave their GP appointment with the most appropriate care plan and medication already in place. This enabled one patient to take “a lovely trip on the train” as the GP was able to change her medication quickly without the patient having to visit hospital. This meant the world to that patient.

All our vanguards and other partners in the NHS have seen significant changes particularly around multi-disciplinary teams. These are not new concepts but the way they are working has changed dramatically.

The emerging view is that the most effective teams include a diverse mix of healthcare professionals employed by different organisations, working from a single location and holding daily case conferences or huddles to discuss patient needs.

Hospital specialists are also going out into the community to see more patients, resulting in fewer emergency admissions. Transfers in and out of hospital for care home residents are more efficient.

The impact and experience for patients is dramatic – better care packages that cover their whole health and care needs, a greater focus on prevention and early detection, and improved support that helps individuals to manage their own health and wellbeing.

There is much more we can do. Earlier this year, the AoMRC reinforced its support for our programme by agreeing a set of shared goals with us.

We wanted to work together closely to promote workforce redesign to improve care and support clinicians. We wanted to share practical ideas for change; and identify ways to address frustrations.

We agreed to keep this dialogue going and the recent event with the Academy was the latest opportunity to share our thoughts and experiences.

It was interesting to hear how important it is to create the conditions for ‘real’ teams to operate. Distinctions were made between ‘pseudo’ teams and committees that are less effective.

Research from Aston University shows that the greater the professional diversity in a team, the greater the innovation in the quality of care – although there’s a tipping point where the team will begin to breakdown if it becomes too large and complex.

Evidence from The Kings Fund suggests that 5 per cent more staff working in real teams could lead to a 3.3 per cent drop in patient mortality. For an average sized hospital that’s about 40 deaths a year.

During the day, a series of vanguards and royal colleges showcased new models of working. The Royal College of Anaesthetists, for example, is helping to prepare patients for surgery in the community; the Faculty of Intensive Care Medicine is developing a new advanced critical care practitioner role; and the Royal College of Nursing is investing in a Capital Nurse programme that offers career clinics to help nurses develop.

In one presentation, I was joined by an ophthalmologist and a psychiatrist – a real indication of the interest among clinicians to work across professions.

Many learning points emerged during the day. We need to encourage leadership at all levels, not just top down. We need to do more to engage public health leaders.

It’s important to find ways to train people in primary and community care and build multi-disciplinary working into education programmes.

We need to recognise perverse incentives, for instance, when changes in staff working times impact on their shift allowances so they get less pay.

Ultimately, it’s about fostering a culture of sharing excellence, resolving barriers that make it hard to expand change across the system, and measuring the outcomes that matter.

I liked the way Dr Sue Goss from the Office of Public Management challenged all those at our event to go where the energy is to change the dynamics from committees to expeditionary forces that ‘dance at the edge of authority’.

We need to create the conditions for a different kind of conversation and the space to build real understanding of the challenges we face. We’re doing this with the Royal Colleges and taking away the key learning points from the day to develop a focus for our next event in January.

Louise Watson

Louise joined the new care models programme in 2015 as the national lead for the multi-speciality community provider (MCP) care model.

In June 2017, she became the Director of the new care models programme and is leading on the implementation of the new care models outlined in the NHS Five Year Forward View.

Louise has over 20 years’ experience working in the NHS. During that time she has held Board level roles spanning both health commissioners and providers.

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One comment

  1. Kassander says:

    Dear Ms Watson
    In the course of your essay, you make a number of assertions, for example

    *The emerging view is that the most effective teams include a diverse mix of healthcare professionals employed by different organisations,… huddles to discuss patient needs.

    *Hospital specialists are also going out into the community to see more patients, resulting in fewer emergency admissions. Transfers in and out of hospital for care home residents are more efficient.

    *The impact and experience for patients is dramatic – better care packages that cover
    … to manage their own health and wellbeing.

    *Research from Aston University shows that the greater the professional diversity in a team,… to breakdown if it becomes too large and complex.

    As you know, Our=NHS practices are said to be Evidence-based.
    I see no hard evidence to substantiate any of your assertions.
    I trust that you will be filling those lacunas in the very near future, please?

    Do please let me know when.