Simon Banks from NHS Halton CCG discusses GP services in Halton - slides from the impact and celebration event held in Leeds on 3 March 2015.

1. Developing a strategy for general
practice services in Halton – A Big
Tent Approach
Simon Banks
Chief Officer, NHS Halton CCG
NHS Improving Quality Impact and Celebration Event
Leeds, 3rd March 2015

2. Why a strategy for general
practice services?
• General practice has been the cornerstone of
primary care in the NHS in England since 1948.
• Basic delivery model has evolved over time
but not radically changed.
• Seismic shifts and environmental pressures in
health and social care.
• General practice under pressure to change.
• Needed to apply local lens and problem
solving approach to emerging thinking on
general practice services.

3. WorkforcePatient experience
Financial/regulatoryDemographic
Ageing population
Increased prevalence of long
term conditions
Increased prevalence of
multi-morbidities
Increased health inequalities
Reduced
practice income
Increased
expenditure by
practices
More quality inspections
Revised procurement rules
Poor use of
digital and
communication
solutions
High usage of
urgent care
Inequalities in
quality of care
Dissatisfaction with
access to services
Physical
environment of
practices poor
Fewer partners,
more salaried GPs
Retirement bulge
Too few
GPs/nurses per
head of population
Increased workload
Recruitment and
retention problems
Impact of clinical
commissioning on time
New, tighter contract
General practice
services in
Halton are not
sustainable
Root Cause Analysis

4. What was the problem?
The problem is that general practice
services in Halton are not sustainable.

5. What was the objective?
By January 2015 to have developed and
agreed a strategy to deliver sustainable
general practice services in Halton.

6. Approach and rationale
• Systemic and systematic, leading and delivering a
change programme.
• Used Strategic Problem Solving model from Yale.
• Involving and engaging as many people as
possible.
• Create a climate for change.
• Agreeing a collective vision of what “good looks
like” before exploring solutions.
• NHS IQ as ‘honest broker’ and NHS Change
Model to build solutions.
• Burning ambition over burning platform.
• Big Tent.

7. Implementation (1)
• Stage One – Developing a shared
understanding of the problem (October
2013 to July 2014).
• Stage Two – Moving systematically
towards a solution (July 2014 to December
2014).
• Stage Three – Execution (October 2014
and beyond).

8. Implementation (2)
• Establish sense of urgency – remove or reduce inertia.
• Visible, active and shared leadership – strong guiding
coalition.
• Develop an evidence based narrative – compelling vision
and strategy.
• Engagement, engagement, engagement – communicating
why, seeking help with the how and the what.
• NHS IQ workshops – accelerator, empowering people to act.
• Subject focused work streams – facilitate contribution,
create short term gains (or JDI).
• Managing people, managing the system – dedication,
sacrifice, creativity and knowing your bureaucracy.
• Programme Management – dedicated resource.
• Burning platform to burning ambition – come with us.

9. What was the contribution of the
NHS IQ team?
• Knowledge, expertise and experience.
• Enabling and facilitative approach.
• Supported work, did not do it – ownership
remained with the CCG and partners.
• Change model and associated tools.
• Discipline, preparation and focus.
• Flexible.

10. Learning (1)
Problem solving
• Systematic and systemic.
• Understanding why before how, outcomes sought before solutions
created.
• Be candid – if things are wrong, say so.
• Counter anxiety and negativity by seeking positive solutions.
• Problem solving is about task and relationship.
Working with groups
• Guiding principles for managing representational groups (Berg,
2005) – they work.
• Don’t “herd cats”, establish an environment for engagement of the
many, coercion does not work (Kotter, 1996).
• Search out the discontented, disconsolate and disappointed – find
out why and work with them – but don’t wrestle pigs.
• Informed people do not fear change – understand if not support.
• Create a movement for change - dancing men (Sivers, 2010) and
snowballs (Fuda, 2014).

11. Learning (2)
Impact on self and others
• Change needs to be led, change management is
an oxymoron in a world of VUCA (Fuda, 2014).
• Ask why before how and what.
• Inspire hope not fear – anxiety is contagious and
destructive.
• Leadership is a state of mind and an approach not
a position.
• Understand and do not underestimate your
personal impact.
• “Are you good enough to get better?” (John
Wooden)

12. Questions and comments?