I became acutely aware of the interest in failure last summer in a post lunch workshop at the SAPC conference (Society for Academic Primary Care). I was droning on about two practices we were working with, in the same building, same size, same demographic. One was flying, the other failing. Suddenly everyone woke up and started quizzing me.
We need to know. We love keeping in touch with practices who have begun the journey, even more importantly now for the NIHR funded “Tele-First” research programme into our practices, led by Professor Martin Roland with Cambridge/RAND Europe. The current tally is 65, of whom 51 are doing well as far as we know, 6 have reverted and 8 partially so.
Why have 22% more or less failed?
- some could not adapt to becoming demand led
- one was sunk by reception (usually the biggest winners)
- one had a patient revolt (while overall 61% say it’s better)
- one did no preparation and gave up after 2 weeks.
- the common thread is lack of leadership
You’ll notice, cough, that none of these reasons are our fault. We are hard-wired as humans to avoid blame. But in that case we would learn nothing, change nothing and be doomed to repeat every failure.
We have had to change, refine, develop, add and delete resources, you name it, continuously, to address all of these. Leadership is particularly important and particularly hard to do.
The result is a subtle and sophisticated intervention, yet simple on the outside. Much of it appears counterintuitive, making it harder to explain, but that’s what works.
78% working is not good enough, and I’d dearly love to get to 100%. What does working well look like? Let me share with you this good news story which is just what GPs need, but it won’t grab the newspaper, TV and radio headlines. It’s a wonderful video of staff and patients at Bourne Galletly practice in Lincolnshire.
One of the counterintuitive changes they have made is to rotate one GP each day to work in reception. Amazing effects on the team, understanding each other, cutting out messages and rework as problems are solved then and there. We’re advising all our practices to do the same. We have learned.
PS Glad to report, by the way, that I’ve done the Waypoint meeting this month with both practices I mentioned above, both now thriving.