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Network Puzzle




Many will have read diligently this past week the NHS Commissioners Primary Care Network Direct Enhanced Service (DES). The impact of this DES is one of vast significance, with practice mindset focused historically on its on patient list size, the noticeable shift here is that practices will need to think more about 100% coverage and delivery of services to population on the scale of up to 50,000 patients.


Many are viewing the service lines, such as; Improved care for those who are house bound, in care homes, in isolation, and those who are high intensity users of the system, improved structures for medication reviews, and improved social prescribing, and self care/management for patients via improved care planning approaches. Indicators have been removed from QOF to a total of 31% of the 18/19 total, and there are some new indicators coming into play which help to focus on long term conditions management such as diabetes, COPD, blood pressure, weight management and cervical screening, and by 2021 tacking neighborhood inequalities will be an indicator.


However with all this change, and contractual documents to read, its imperative that all those involved in the development of the primary care networks understand the three 3 key rules of engagement, and I write this post as someone who currently manages the business and operations for a Primary care network of 70,000 patients and a workforce of 250 staff.


Puzzle Piece 1. Celebration

At the most basic level, there are fears that need to be dispelled. One practice may feel like it has ceded power and autonomy to another, one leadership team bows to the other. In these circumstances, it is so important to simply start by pointing out that not only is everything going to be just fine – it’s actually about refocusing everyone’s emotions on the huge opportunity to be part of something bigger and better, in scale, shared expertise and potential. Practices should put aside their fears of being threatened by larger players with greater powers of economy of scale within the network, which can be difficult for small practices who believe that some form of network acquisition is a matter of survival. So start the journey on a positive note and show that everyone can take part in this Network success, by starting with a tone that speaks of immense potential, you at least make it possible for those heights to be reached.


Puzzle Piece 2. Recognition

It is particularly crucial to ensure that the leadership group of all practice(s) (particularly if there are some who have been acquired as part of a merge, or contract take over) are clear that just that they are valued, but to qualify why they are valued. Not only does this explain the reasons for the acquisition in the first place – it also establishes a positive, accepting culture that shows a desire to create a new culture that is greater than the sum of its parts. By going through the initial step of visibly recognising what is worthy and valuable from both the acquired and acquiring practice(s), it is possible to begin to glimpse a new, shared world together.  Without recognising the values and culture of that practice, not only do Networks risk missing out on taking the best parts of the acquired practice(s) along with them, they also risk alienating the employees of those practice(s) who are at the delivery end of patient care. Continually reassure the workforce that they are a key piece of the puzzle, and that their expertise and knowledge are valued.


Puzzle Piece 3. Expectation

This is the area which is forgotten the most, and revisiting it retrospectively can become difficult, because new habits, behaviours and cultures may already be formed. Nether the less once you do understand each individuals capabilities and expertise you should clarify exact expectation for utilising them, both on an individual level, team level and Network level. To set expectations early on, sets a tone of open and honest communication, and when open and honest conversations can be facilitated to deepen understanding about the detail of these expectations, so much the better. Each Network that forms, will be different; have its own dynamic, its own challenges and opportunities, but expectations of behaviours and deliverables will not be too dissimilar.


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