The New Care Models programme was launched to redesign patient care and established 50 vanguards up and down the country. It was clear from the start that these ambitions required collaborative leadership with the courage to explore fresh ideas. Leaders from one community in the south-east of England tell their story.
Heretics at large
Dispelling her initial misgivings, Mandy immersed herself in the programme, laughing as she reveals that her leadership group badged themselves the ‘heretics’. “I wasn’t sure what I was going to get out of the programme but I thought: I am passionate about community health; I know it inside out. It’s all very well having people up above with a vision but we clinicians need to keep them grounded. We need to ask: is this going to work for patients?” The 2020 Leadership Programme is led by Dr Peter Bibawy, Medical Director at North East Hampshire and Farnham vanguard, with the support of an Executive Board and system leaders across the Frimley Health and Care Transformation and Sustainability Partnership and Thames Valley and Wessex Leadership Academy. “The programme is built on cross-organisational collaboration, portraying leadership across a pioneering health system and reaching out to other public sectors, for example the military,” says Peter. “Open to all clinicians and managers working in the FH STP, the programme breaks down organisational barriers and prides its richness on the diversity of seniority. The changing face of the health, social and public sector needs a cadre of innovative and empowered leaders, leaders who work at the coal face of service delivery. The system needs influential individuals who understand the needs of their local population and who will work across traditional boundaries to make change happen.” So we designed the programme to create an environment of collaboration, trust and freedom where leaders can step out of their normal setting, away from targets, processes and hierarchies.” Programme events and residentials included public sector collaboration, for example with the military and private sector learning through corporations like Microsoft. They also developed new connections between communities, for instance by involving local hospices; and bridged gaps between policy makers, front line staff and communities. Karen Hampton, NHS Surrey Heath’s Head of Quality, says: “I wanted to learn about different leadership styles - how to influence and challenge decisions, how to manage difficult conversations. When we went to Sandhurst, I had a kind of ‘eureka’ moment. I realised this wasn’t just about the NHS. We can be very blinkered; it’s about a sense of place and the impact we have on the community around us.” It’s interesting that leaders on the programme talk about a visit to a drop-in homeless centre, and having breakfast in an office block where children came to read for an hour before each school day. This was redefining their idea of ‘community’. The 24 Fellows on the programme each had to adopt a change challenge. Mandy and Karen came together with four others to locally launch the National ‘Red Bag’ scheme across six CCGs – improving the transfer of care home residents in and out of hospital. “I have been in the NHS 26 years,” says Karen, “and this was a brilliant opportunity to get a better understanding of the wider Frimley Health and Care STP footprint, to learn from other vanguards about integrated care, and join other colleagues in mental health, social care, district nursing and secondary care.” Mandy, who works for Virgin Care as one of the contracted community health providers in North East Hampshire and Farnham, says: “I learnt that if you’re not willing to make mistakes, you’ll never affect change. Be a heretic! Have the courage to think out of the box and have a go. The nursing profession sometimes doesn’t have a high opinion of itself but we do have ideas, we do have vision.” The 2020 Leadership Programme set out some clear principles around having courage to innovate, involving the community as partners of change, being able to adapt and be resilient to change, with a focused bias on action. Theory and inspiration were key components but, ultimately, people have to take action to deliver lasting change. Angela Murphy, Deputy Director for Hampshire CCG Partnership and Lead for Children & Maternity Collaborative working across the five Hampshire CCGs, says: “The beauty of this programme was leadership at every level. Everyone was on an equal footing – consultants, directors, nurses, GPs, physios. This is its Unique Selling Point. “I work across a complex landscape and I wanted to work across the system without barriers, and learn from others with different skills and disciplines. It made me realise the power of people when hierarchies don’t matter - everyone had something unique to bring to the discussions.” Angela’s Change Challenge, as lead for the Children and Maternity Collaborative across five Hampshire CCGs, was about improving care for children with Autistic Spectrum Disorder and Attention Deficit Hyperactivity Disorder. “We were faced with a number of challenging circumstances around community services, affecting children and their families. The programme helped me with some techniques to use when meeting with parent groups. When I met those parents, my worries were turned completely on their head. Essentially, they wanted the chance to share brilliant ideas to resolve real-life issues that they and their children face – and we continue to work with them to co-design service change. “What’s been brilliant is the parents were empowered to design a system that worked for them. They have launched their own website, which they developed with young people, turning a very negative position in to something rewarding and positive for parents.” The New Care Models programme at NHS England has been supporting vanguards to adopt a systems leadership culture to integrate their delivery of services. Learning and development support has focused on communities of practice, sharing experiences and working collaboratively on solutions. |
 Happy delegates after their session in Gosport. |
Don’t stop me now!
Megan John describes herself as ‘half human, half Duracell’. Juggling life as a busy GP, Megan’s recently led an expedition to the Atlas mountains to deliver medicine to the Berber community – at one point finding herself on a mountain trail with a certain Richard Branson. And our intrepid physician has just returned from Namibia filming a children’s TV programme with people affected by teenage cancers. But 12 months ago, even Megan’s drive, energy and desire to transform patient care - was receding fast. “I have always wanted to be a doctor. It’s a wonderful job. But we are currently attempting to work in an incredibly difficult climate and many GPs have developed a hard resistance to the constant change expected of them,” she says. All her efforts to galvanise the GP community into a collaborative force were coming to naught. “I was trying to build connections with GP practices. I was just getting ‘nos’ all the time. The negativity could be horrendous, and I was losing my resilience and motivation.”
The programme enrolled 24 fellows onto the programme, including Megan. Using the networks the programme gave her, and drawing on her renewed confidence and skills in negotiation and leading change, Megan created time and headspace to discuss and plan how the GP practices could work together at scale. Megan also obtained business support to drive forward the project. “2020 helped me to get the weight of the CCG behind me and we discovered there was a huge commonality across primary care – and the energy and positivity began to resurface. We now have eight practices working together as a cluster hub. Two practices are going to formally merge next April, and we have memorandums of understanding for collaboration across six workstreams.” These include:
“2020 made us redefine our interpretation of leadership and our sense of community. I am involved in training doctors and I provide peer support but I wanted to develop that further to build positivity and energy in primary care. So I posted in an online forum for primary care workers and asked who was happy? The response I got was incredible - 74 doctors posted directly to the thread. Yes, there was still some negativity but more positivity than I anticipated. “Using this momentum, and a clear desire for ‘joy’ in primary care, I contacted various organisations I’d come across through the 2020 programme, and one community interest company agreed to work with me. We are hosting an event in London in January for us to share what creates a positive and happy environment in primary care. We hope to take that learning and turn it into the DNA for great primary care.” “2020 re-invigorated me. It provided me with new networks and, with the CCG behind me, it legitimised what I had been trying to achieve,” says Megan. “At no point did the program stop us from doing more than they asked us to do. It skilled us up to move forward, to think bigger, to ‘go fly’ – and we are seeing delivery far beyond our original intentions.” |
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In the pinkJennie Ford doesn’t do things by half measures. When Jennie joined the Frimley Health and Care System and Transformation Partnership’s Leadership 2020 Programme, she chose ‘raising the morale in the NHS’ as her project challenge! What? All of the NHS, you might ask. “Starting with my surgery,” says Jennie, who is Practice Manager for Sandhurst Group and the practice manager lead for Bracknell & Ascot Clinical Commissioning Group in Berkshire. “I have been in primary care for 10 years. When I first started, I couldn’t believe how different parts of the NHS were always blaming one another. We have to get much better at this. We need to talk to one another, and it’s incredibly important that we understand the pressures others face in the system.”
Other participants on the programme include NHS Surrey Heath’s Head of Quality, a community matron and integrated care team leader, the Children and Maternity Collaborative lead working across five Hampshire CCGs and a GP in Bracknell – and many others. Jennie was struck by programme sessions on mindfulness - encouraging individuals to find the time and space to reflect on their day-to-day working lives and how they impact on others around them. Her first thoughts were around behaviours in her practice and these developed to consider interactions with other parts of the system, and how decisions made in GP practices might have a negative ripple effect elsewhere. “I was talking to a paramedic who said to me ‘don’t steal all our paramedics for home visits’ and that made me think of the wider impact you have on the system. We were finding solutions to our problems which may unintentionally create a pressure on other services in the system.” The programme helped Jennie to think about how they were managing a contentious issue with their local hospital as well as their contact with patients in the surgery. There were challenging interface issues with our local acute hospital over an issue with electronic referrals and the availability of slots for appointments. I thought they’re under as much pressure as everyone else – we just need to talk to one another and solve the problem together. ” While on the frontline with patients... “Little things matter – taking time to talk with a patient can reverse negativity. We often jump on the defensive when we have difficult patients and the atmosphere can quickly become fractious. If we respond nicely they’ll relax. Conflict exacerbates the stresses and pressures we are already facing, not only leading to poor patient experiences but higher sickness levels and difficulties in retaining staff.” The 2020 Leadership Programme set out some clear principles around having courage to innovate, involving the community as partners of change, being able to adapt and be resilient to change, with a focused bias on action. At the heart of these values was empowering ‘leaders’ on the front line. This shouldn’t translate into hierarchies that create barriers. Jennie says: “One of our surgery’s targets is to increase cancer screening and I asked one of my team to lead Wear it Pink breast cancer awareness. The team were really energised by it. Cancer is a serious issue but it needs to be promoted in a memorable way, and the team are having some fun in the process.” Further notes:The New Care Models programme at NHS England has been supporting vanguards to adopt a systems leadership culture to integrate their delivery of services. Redesigning patient care requires collaborative leadership with the courage to explore fresh ideas. Learning and development support has focused on communities of practice, sharing experiences and working collaboratively on solutions. The 2020 Leadership Programme is led by Dr Peter Bibawy, Medical Director at North East Hampshire and Farnham vanguard, with the support of an Executive Board and system leaders across the Frimley Health and Care Transformation and Sustainability Partnership and Thames Valley and Wessex Leadership Academy. “The programme is built on cross-organisational collaboration, portraying leadership across a pioneering health system and reaching out to other public sectors, for example the military,” says Peter. “Open to all clinicians and managers working in the FH STP, the programme breaks down organisational barriers and prides its richness on the diversity of seniority. “The changing face of the health, social and public sector needs a cadre of innovative and empowered leaders, leaders who work at the coal face of service delivery. The system needs influential individuals who understand the needs of their local population and who will work across traditional boundaries to make change happen.” “So we designed the programme to create an environment of collaboration, trust and freedom where leaders can step out of their normal setting, away from targets, processes and hierarchies.” The New Care Models programme at NHS England has been supporting vanguards to adopt a systems leadership culture to integrate their delivery of services. Redesigning patient care requires collaborative leadership with the courage to explore fresh ideas. Learning and development support has focused on communities of practice, sharing experiences and working collaboratively on solutions. |
