Supporting New Ways Of Working In General Practice
Ockham Healthcare is a think tank and consultancy who work with CCGs, federations and individual practices across the UK to support working at scale. We spoke with Founder and Principal Consultant, Ben Gowland, to learn more about how Ockham Healthcare supports new ways of working in general practice.
When I left the NHS in 2015 I had been a Chief Executive in Northamptonshire for 8 years, firstly in the country’s largest Practice Based Commissioning Group, and then with Nene CCG. Prior to that I had been an acute trust Director in London and had also run national improvement programmes.
With the advent of CCGs, I began to realise that the way commissioning in the NHS was developing had created a debilitating distance between what I was trying to achieve in a central role and what was actually happening in core general practice.
Feeling that my hands were effectively tied by the bureaucracy and by “top-down” national directives, I was inspired to launch Ockham Healthcare. I remember saying at the time, “I have spent 20 years working in the NHS system. I want to spend the next 20 years working on the system. I want to make the system easier, more productive and more fulfilling for those who work in it, and easier to understand and more responsive to those who need it. I believe the platform for change that Ockham Healthcare creates is the best way for me to do this”.
Ockham Healthcare helps practices tackle current pressures and, at the same time, works with them to build a compelling vision for the future.
We started off working with practices who were struggling with individual challenges, helping them to understand how to meet them and move forward. As we developed, we increasingly responded to what GPs and local areas wanted, which were things like understanding how practices can work together in groups and support each other, and how practices who formed groups can respond to the integrated care and accountable care systems agenda.
Right from the start we have tried to promote and share the innovative stuff that was happening across the service through a weekly podcast interviewing key clinicians and managers from across the country. It’s proven to be a great vehicle to help people understand that things can be done to influence change, and that it’s important to learn from the experiences of other people who have been successful.
When we started it 2 years ago, I was really excited when we achieved 100 downloads in 4 or 5 weeks. But in May 2018, we hit 4,000 downloads in a single month, and now we’re about to achieve 50,000 all-time downloads. It’s been an incredibly enriching experience for me and I know, from speaking to GPs up and down the country, that it is really valued by our audience.
As an organisation, we’re trying to make a difference to general practice as a whole. What really motivates me is helping to move general practice from where it is now, to somewhere more positive overall.
General Practice at Scale
In the past, GPs and general practice have tended to be inward looking. But in the new world, that is no longer appropriate. One of the keys to survival now, particularly in relation to the new models of care, is to become outward looking; to build new relationships, such as those with other practices and with local hospitals.
Those in leadership positions often need support to help them build these relationships, and that’s where Ockham Healthcare can help.
Developing new working relationships in order to meet the challenges of the future is difficult, and it can be hard to know where to start. Often GPs and practices have very limited experience of working with senior leaders of NHS organisations, and have really valued our support in helping establish these new relationships.
The system is also changing so fast at the minute with STPs, integrated care and the like, and it is hard for practices to keep up with these changes, as well as tackling the day-to-day pressures they face. One of the things that we do is help general practices work together to prepare and be in the best possible position for the changes that are coming.
Retention in General Practice
The current crisis in general practice can appear overwhelming, but at Ockham we have been supporting practices through what often amounts to despair and help them see:
- What are the things over which you have control that could move you forward?
- How do we create something we’re really excited about and that challenges us?
- How do we attract more GPs with this vision and get them to stay longer?
There are so many factors influencing the future of general practice.
As well as the integration agenda and the rapidly changing infrastructure of general practice, there are technology opportunities (such as Lantum). There’s also the fact that millennials are different to the current generation. It’s important to see that as an opportunity, not a negative. How can we turn that into something inspiring for general practice?
Recruiting 5,000 new GPs as part of GPFV wasn’t realistic when it was first published, and isn't realistic now. Retaining the GPs we have and creating an environment they want to work and stay working in has to be the priority of our focus.
As I look around the country, I see things happening in pockets that are very energising when there has been a shift from a focus on the negative factors influencing general practice to thinking positively about what can be done.
Two things stand out in these areas.
First is that GPs there are thinking really creatively about what only they can do, and how they can empower others to do the rest.
Second is that there is a focus on how the practice can impact on the health of the community and make a difference, not just to the patients that present, but to everyone by working with other partners and agencies.
For example, practices in Fleetwood have taken a leadership role in improving the health of the entire population through the Healthier Fleetwood initiative. They are working with schools, restaurants and the council to make the whole community healthier, and to influence the shape of demand in the future. That kind of mindset gives a much more inspiring vision for what's possible to do for general practice to attract new GPs, and also to keep the ones that we have not just for 3-4 more years, but for 20 years into the future.
Leadership in General Practice
It's a really important time in general practice for those who want to take on a leadership role. In a lot of areas, general practice still doesn't have a voice at the senior table of decision making around STPs. GPs need to take a more active role in driving and shaping the agenda. We’re making strides with the primary care home movement, but we’re not there yet. We have been helping practices in local areas think about how they can take a more active leadership role in driving the integrated care agenda locally.
For example, Ockham Healthcare has been working with the GP practices and federations in Surrey, who are 1-of-9 ACS pilot areas to become an accountable care system. We have been helping them prepare for the changes ahead, thinking through how their relationship with the CCG needs to develop, how the relationship between the practices and the federations needs to evolve, and how they create a strong collective voice in system wide discussions.
Founder, Ockham Healthcare
Check out the recent podcast featuring Lantum’s GP Co-Founder, Dr Ishani Patel, on technology to mobilise the general practice workforce.