The document discusses the author's journey from clinical leadership in the NHS to becoming Group Medical Director of One Medicare, an independent provider of primary care services. It outlines the development of the independent sector in primary care in England and describes One Medicare's vision and clinical leadership program. Both opportunities and challenges of working in the independent sector are presented. The author advocates for greater networking and sharing of best practices between the NHS and independent sector to improve patient care through clinical leadership.

1. The Road to
Independence: clinical
leadership outside the
NHS
Dr Richard Jenkins
Group Medical Director
One Medicare

2. Content
• External environment context: the developing market in NHS
England primary care
• Internal environment context: One Medicare
• Overview of my leadership journey
• Insight into the One Medicare clinical leadership programme
• Pros and Cons of the independent sector
• Potential for links and shared best practice for continual
improvement

3. NHS England Primary Care
• Historic GP practice protection from contract and regulation
restrictions is being steadily eroded:
• GP Equitable Access (Darzi) Centres
• APMS contracts
• OOH
• Prevention of PCT acting as providers including PCTMS
contracts
• AWP and subsequent AQP
• Section 75 of the Health Act
• Political will

4. Increasing Opportunities
• For independent service providers
• For breaking down the boundaries between care sectors
• For innovation
• For demonstrations of quality, efficiency and productivity
• For doing things differently

5. One Medicare
• Established 2006 as a start up business
• Primary care services provider
• 350,000 patient contacts per year and growing
• 8 service centres and growing
• AQP service provider
• In a group structure with One Medical, a premises solutions
expert and developer

6. Vision and Values
• Our Vision:
Ready to challenge tradition,
we are proud to lead the way in
designing innovative solutions,
delivering state of the art services
and facilities and demonstrating
unrivalled commitment to client
satisfaction and patient care.
• Our Values:
• Patients First
• Commitment
• Professionalism
• Positive Relationships
• Innovation

7. My Leadership Journey
• GP Partner in 14,000 list practice
• PCT PEC member
• PCT Prescribing and Clinical Governance Lead
• NHS Institute for Innovation and Improvement
• Programme Lead for Innovations in Healthcare
• Commenced my MBA 2009
• GMD One Medicare 2011

8. Motivation for the change
• Interest in business and doing things differently
• Belief in the value of clinical leadership
• Frustrations with NHS
• My mentor
• The MBA
• Being in a role where you can make real change happen

9. Motivation for the status quo
• Well remunerated
• Risk of leaving the NHS security blanket
• Risk of entering a market economy
• Risk of failure
• A significant step into becoming an manager and not a
clinician
• Colleagues perception of crossing to the independent sector

10. Our Senior Leadership Team/Board
• Sir Vernon Ellis, Chair of The British Council and previous
World Partner for Accenture
• Michael Beverley, previous UK managing partner Arthur
Anderson
• Rachel Beverley-Stevenson, background in marketing and
innovation
• Me
• Stuart Jobbins, background in large commercial property
services
• Caroline Day, background in retail
• Paul Charlson, GP, background in politics and policy

11. OMC Clinical Leadership Programme
• Based on the Medical Leadership Competency Framework
• 6 month launch programme
• Half day per month protected
• Action learning sets with ‘homework’
• Group and Individual approach

12. Launch Programme
Month
• 1: Personal development and qualities
• 2: Internal and external relationships
• 3: Managing services
• 4: Continual Improvement
• 5: Strategy and setting direction
• 6: Bringing it together and graduation

13. Maximising the value of the group
• Bi-monthly in person meetings with clinical and operational
leads from whole group
• Each meeting aligned with a OMC value
• Each centre leads a 2 month time window
• Rotate meetings through centres
• Alternating CEO presence
• Action learning activity and outcome driven evaluation

14. Monthly Performance Review
• In person with GMD, FD, PSD and leadership team for each
centre
• Periodic CEO attendnace
• Integrated governance based review
• Outcome driven using dashboard of metrics
• Risk register and clinical governance templates
• Events, complaints and compliments
• Profit and Loss and budget review
• Resource review
• Continual improvement review

15. Leadership Network
• Weekly phone call between GMD and each centre clinical
leads as a diary commitment
• Group Desktop intranet and Forum
• Clinical leads network
• Membership of FMLM
• Registered with IHI, NICE and The Kings Fund email systems

16. Maintaining, Developing and Retaining
• What do you like to do?
• What are you good at?
• What does the organisation need?
• How can those dovetail?
• Improvement training and change management
• Conflict resolution

17. Leadership Model for Transformation
Source Amicus
Technical and human
dimensions of
change
Critical mass
feels urgency
for change
Broad and deep
commitment to
shared vision
Chose ONE
improvement
model
Compact
aligns
expectations
and vision
Visible and
Committed
leadership

18. One Improvement Model
• Take your pick:
• Lean and TPS
• Six Sigma
• Model for Improvement
• NHS Change Model
• Total Quality Management
• Business Process Redesign
• Etc, etc.
• But stick to one

19. Critical Mass and Urgency
• Don’t assume
• Be deliberate
• Burning platforms
• Burning desires

20. Shared Commitment to Vision
• Our Purpose:
We are shaping the future of healthcare throughout the UK
• Our Vision:
Ready to challenge tradition, we are proud to lead the way in
designing innovative solutions, delivering state of the art services
and facilities and demonstrating unrivalled commitment to client
satisfaction and patient care

21. Where is your focus: values or compliance
• Compliance Based• Values Based

22. Visible and Committed Leadership
• Be visible
• Live your values
• Understand what motivates your team
• Be intolerant of the sub-optimal
• Be humble
• Be consistent

23. Humble Enquirer
• Training and check list sheet
• Seeking improvement:
• What is frustrating you at work?
• What problem keeps recurring?
• Where do you see waste and inefficiency?
• When did you last have to work around a process failure?
• Where do you see inconsistency?
• Seeking best practice:
• What went really well last week?
• What problems have you or the team resolved lately?
• What makes you feel content and valued at work?
• What do you do well that you can share with the wider group?
• When did someone last say thank you to you at work?

24. Personal Mastery
• Deliberate training in keeping a focus when things get difficult
• Overcoming the reptilian brain
• Reflective Practice

25. Compact
• We will continue to support your
• professional and personal
• development
• Leadership opportunity escalator
• Commitment to development
from all senior members of
leadership team
• Individual and group development
in leadership and business operations
• You will continue to build
your contribution and value
to the organisation
• On going benefits will be linked
to demonstrable performance
• Commitment to further
development in both
leadership and business
operations
• Building the capabilities and
success of your teams and
centres

26. The Independent Sector
• Growing arena and in the majority with a focus on the value
of clinical leadership
• Things are done differently to the NHS
• My experience is in the primary care services sector
• The sector offers both opportunities and challenges

27. Opportunities
• Understanding business
• Coaching from former CEO Yorkshire Building Society and
Arthur Anderson HR Director
• Support for my MBA studies
• Networking outside the health sector
• Training in financial and accounting understanding
• Access to and learning from alternative industries
• Looking at problems with an alternative lens

28. Opportunities
• Intolerance of the Status Quo
• Embracing an ethos of continual improvement
• ‘Stand Still and Die’
• The ability to really shape systems and processes
• Control and metrics
• New opportunities and growth
• Horizon scanning and relationship building

29. Challenges
• Isolation
• Perception of some towards the independent sector
• Time limited contracts
• Politics
• The NHS reluctance to change, particularly General Practice

30. Challenges
• Recruitment
• Attracting talented clinicians to the independent sector
• Fear of time limited contracts and stability
• Unsure of a different approach
• Retention
• Effort put into leadership to be lost to GP partnership roles
• Focus on value adding and development for talented clinical
leaders
• Offering opportunities and development not found in normal
NHS/General practice

31. The Future
• On-going development of the leadership programme
• Focus on identification and retention of ‘high flyer’ clinical
leads
• Working towards the microsystem theory and leadership at all
levels

32. Future Networking
• Bridging the gap between the independent and NHS sectors
• How can we network better to share best practice and
improve patient care
• Can the independent sector be seen as a valuable part of a
clinical leadership career and development path
• Breaking down the ‘artificial’ barriers between clinical leaders
in the NHS and the independent sector

33. High Quality Patient Care
• It is a shared outcome for clinical leadership throughout the
health care environment
• There is no silver bullet answer to achieving this
• Together I believe we would be stronger and sharing clinical
leadership best practice between all sectors would be
beneficial
• The FMLM can be a lever in achieving this

34. Questions and Comments