Working at scale – Ensuring it benefits General Practice in complex and demanding times

Understanding how ‘working at scale’ works best for general practice

When it comes to general practice culture, implementing primary care solutions ‘at scale’ is an interesting conversation because it is not universally considered to be a good thing. We approach our work as an opportunity to learn what works well at scale – and what’s really done well in much smaller, bespoke units.

This means being brave enough to stand up against the national narrative and beginning by listening to what matters to GP practices. We are here to help them understand what best practice is for them, in order to meet the particular needs of their communities. We provide an opportunity to connect and collaborate with colleagues and other practices to create a learning network to gain insights around each other’s best practice.

It’s an opportunity to start to explore, together, the collective problems we’re trying to solve and how best to do this. This means practices are not battling in such an isolated position. We can combine knowledge and shared skills to mean Primary Care is stronger. The impact this can have on general practice culture is to create a greater sense of autonomy, being in control of our own destiny. This begins with Workflow – tackling some of the really negative pressures around escalating workloads in GP practices.

Beginning with Workflow

The reason Workflow is a good programme for providing that opportunity to collaborate is because it creates good ground for clinicians to learn and engage. Why? Because they understand the benefit that is achievable in releasing themselves for 40mins per day per GP of clinical correspondence – less unnecessary admin and more time to spend thinking about complex decisions to do with people’s care.

We know that it is hard for GP practices when it comes to implementing new ways of working that are sustainable and allow for the general ebb and flow of general practice, staff movements and periods of stress like CQC inspections. Everyone is so busy, it is really challenging to create head space, trust and time to change what we do.

Workflow Network is an opportunity to maximise the benefits of Workflow because it means you can learn to collaborate with your neighbours around a really positive programme of work – create a service which is resilient, sustainable and offers a reliable day-to-day benefit to all the people connected with the practice.

Forming the foundations for wider development

This way of working at scale helps CCGs and Health Boards achieve their strategic targets around enabling GP networks to actively share the delivery of primary care services – taking conversational relationships (which are really important in developing trust) towards the critical development of local organisational structures that they need to invest in.

So, they have an opportunity to use this as a programme not only to release more GP capacity but to also hit one of their national targets – a real win-win for CCGs and Health Boards. Our work also starts to create organisational development within general practice and working at scale allows developments in strategy around practices collaborating and developing sufficient skill and expertise to start running clinical services.

Maximising our achievements through shared purpose

Many of the interventions around general practice at scale to date have taken a ‘top-down’ approach, led by organisations or structures and without a clear purpose of what’s trying to be achieved – very much focused on form and structure. Our approach to collaborating means it is far more relevant for mainstream general practice and as a consequence we see much better results.

Our specific methodology makes sense to GP practices as we understand the importance of spending time together and listening to what matters to each other in the room –what are the shared problems that practices want to fix and using this conversation to bind the group together, ultimately creating a shared purpose. By investing in that early time together we really catalyse the decision making process and maximise what’s achievable further down the line.

Because of that shared purpose, trust and leadership is developed at such an early stage, we can really embed success in to the programme. It’s what makes our approach really different to others and achieves us increasing recognition, backed by popular thought as the best way to approach at-scale working.

Creating stability in unsteady times

At the moment, general practice is very unstable and we are seeing significant volumes of surgeries resign their GMS contracts and fold. An unstable primary care is bad for everybody – communities, clinicians, hospitals – everybody.

So, creating a platform of stability can only be a good thing – something to embrace, expand and build on in order to enhance people’s experience of primary care and allow them access to healthcare in the community that is more person-shaped.

Having learned how to deliver Workflow Network my vision is to be able to apply our methodology to other primary care challenges such as access, medication, or any other problem area that a group of practices want to put some collective energy into. Having an honest conversation about at scale working and going on an exploration of what is actually better (and having the courage to say what is going to be worse!) involves GPs, the wider clinical team, Managers, and members of the community, and to be honest anybody who wants to join the conversation as this issue affects us all either as providers of the service, or as users when we have a primary care need.

I believe the end point will be different for different localities, depending upon the collaborative maturity and populations – but what I hope is that every practice gets to embark on that discovery, with funding and support to make sure they do that really, really well.

Sharing our vision for the future

Our purpose (to create distinct and vital shifts in Primary care: bring people together, unlocking possibility and creating space for change) is a principle in how we operate – full stop. So, it informs how we attempt collaboration and every interaction with a group – we really want to understand what matters to them in order to create shared purpose and vision. We represent a distinct difference to top down reform. It’s how we know – irrespective of what the programme of work is – we’re making a meaningful difference. We have a belief in ourselves and we can support people who are representing communities to make a difference.