Developing leaders across systems

The Senior Medical Advisor to the Primary Care Provider Transformation looks at what can make integrated care thrive:

Health and care services across England are going through a period of transformational change, moving from silos to coordinated working, and from fragmentation to integration.

To make the most of this journey together, we need to develop leaders with the ability not just to lead a single organisation but to lead across boundaries and among communities, through greater cooperation and connections.

As health and care leaders developing integrated care, we no longer work in relative isolation, so we need an ever greater capacity for active listening and reflection, empathy and understanding of others’ needs.

To deliver successful integration we must forge closer ties with social care, the voluntary sector, patients and carers, plus the wider landscape of partners including housing and education. With this widening engagement comes an increased need to help people move forwards together in a spirit that supports each other’s work, and a bottom up approach that gives local clinicians and others working on the ground permission to innovate together.

Such system-wide leadership requires the ability to look outside our own environment, consider the impact that our decisions have on others and the possibility of unintended consequences for others when we make changes, and understand the challenges but also the opportunities of a more integrated workforce and financial plan.

In many ways, leaders of single organisations can act in fairly quick, decisive ways; that’s not the case when leading across multiple organisations and juggling system priorities with potentially competing individual needs of organisations.

The first step to delivering the transformational change needed is for partners to work on developing a common vision of the goal in sight, and gaining consensus by building trusted relationships, often starting with changes that are small and organically grown from the bottom up.

In Dorset we run a joint leadership course across a range of organisations – GP practices, the local authority, and the community and hospital trusts. We have replicated this for leaders at a primary care network (PCN) level. It was so valuable to our relationships to undertake cross sectional learning, with the group all embarking on the journey together. We now have a culture where we understand and respect each other’s sometimes competing priorities, acknowledging that while we don’t always agree, we try to work through solutions.

And it doesn’t matter what level of integration we’re talking about – there are the same challenges and opportunities from working together within a whole integrated care system (ICS) or a PCN of a handful of GP practices.

Many GPs are stepping into new clinical director roles, leading change no longer solely within a small environment such as a single practice but also influencing change in other, independent practices. GP leaders will need a real understanding of the system around primary care, the business and financial environment, and the implications of the targets others need to meet, even when they’re not directly linked to their own – just as the wider system needs to understand general practice.

There are many emerging models of great practice: one of our PCNs has pooled resources to develop a highly effective, integrated multidisciplinary team that looks in a coordinated way at the care of frail, complex patients in residential and care homes. The team produces anticipatory care plans that enable GPs and community services to work together to deliver holistic care. This has led to tangible benefits. For example, emergency home visit requests to the care homes involved reduced by about 60% within the first year and over 90% of people died where they chose to do so.

In another project, stakeholders from hospitals, community services and general practice have come together to look at how we optimise care for those chronic obstructive pulmonary disease (COPD) patients with the most complex health challenges, to reduce the number being brought into acute care with exacerbations of their condition.

The project uses a risk stratified approach, offering those at greatest risk support through a multi-professional clinic. For those at less risk, there is an offer for more self-management through app technology.

The challenges of bringing teams together like this will be similar, no matter the scale of the project or size of organisations involved, and so is the ideal leadership model – developing a clear vision, allowing headspace for people to have difficult conversations, gaining trust and developing strong relationships are all key to success.

Some of this isn’t very hard or complicated but this journey does require great leadership.

As leaders, we may need to let go of some of the sovereignty that we have within our organisations and become part of something that is bigger than just the individual; there’s a real power to doing that.

Karen Kirkham

Karen Kirkham has been a GP for over 25 years and is now senior partner in a large practice, combining this with a senior leadership role in Dorset.

She also has a national role as Senior Medical Advisor to the Primary Care Provider Transformation team.

Karen is currently focusing on the redesign, transformation and delivery of the integrated community services and primary care component of Dorset’s STP.

During 2018/19 she was a national clinical advisor for primary care with the NHSE System Transformation team.

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  1. Chris Emblen says:

    Super article.
    Recognising that system, multi agency change will take longer than single organisation change and accepting this when time pressures are on all of us is key.
    Small steps taken together can be giant leaps.

  2. pat set says:

    We need more of this, so important to connect frontline staff to the central theme of caring for our patients in whatever environments they are in. It must be seamless, may be having staff working across boundaries will hasten this transformation- nurses, doctors and allied health professionals should be supported in working in hospitals and in the communities that way staff can better understand the processes etc.. Additionally the government should support the NHS and make use of augmented intelligence to connect teams in all areas as described in the article above.