Hi all.  Yesterdays blog has created a lot of noise and traffic – thank you Roy Lilley of nhs,managers.net – link to e newsletter

If anyone else wants to get in touch who has read the piece and the blog, go via one of my websites

www.philhawthorn.com

or

www.onsetpaheadtraining.co.uk 

Yes, as Roy said today “we never reached a conclusion and it is too important a topic to just leave hanging”.  We do need to stop talking action and start taking action.

Looking forward to hearing from some of you!

Phil

OK – we are talking General Practice here, as most of us know it.  I was at one of Roy Lilley’s Health Chats last night at The Kings Fund in London.

All friends together…

Roy Lilley was our Paxman for the session. He floated questions, hypotheses, challenged, derided, abused and cajoled Claire Gerarda, (past chair of RCGP) James Kingsland (President NAPC) and Mike Bewick (Deputy Medical Director, NHS England). And an audience of GPs and many other interested parties…were exercised to intervene too.

But there was positivity in the title…assuming we do have future need. The title wasn’t about the future of the GP, or even General Practice. It was about primary care.  Here are my madly biased highlights ….it was all so full on and frantic, that I am sure everyone there heard different things, depending on their individual need and their own biases. Ears are tuned differently.

Roy wouldn’t invest if he was presented this model on Dragons Den.   The main question was “what will Primary Care look like in 2020” ( a 20:20 vision if you will!).

…and my second point is…

Roy is provocative, as is the need of the occasion. Even if we don’t believe he believes it, at least people have to defend their position. Suggestion first, possible actions later, and my bits in (parentheses) in the main: Here’s the visions: (Claire, James, Mike: 3 from each)

•  Still be – gatekeeper (good value – 8% of budget, 80% of contact). Saves money and stops you doing stupid, e.g. “cancer tests on demand” – What? What for? Why? (worried well can cost a fortune!) We will still need translators of undifferentiated symptoms.  The world wants and is aiming for a primary care led health service.  Why do we want to go the other way?  (Government hates the BBC too…)
• Get rid of independent practitioner status?  (James disagreed)
• It won’t be like now – I won’t be working from Hurley Clinic – it will be more Lambeth Primary Care Organisation
• Primary Care Multi-Specialist team, mainly in the community still
• Will still be personalised care – efficient care system, not disenfranchised
• PBC will re-replace CCG! (Full circle, history repeats – pendulum always swings fully in change management – need to stop the extremes…)
• 300 000 needed for efficient commissioning
• Health and social care need to be together and seen as holistic (like it used to be?)
• Let the technology breathe – near patient testing, ambulances containing clinical expertise, change our heads!

And here’s some of the other highlights (for me): Questions are Roy’s, in the main.

• “Wny not just have it in Tescos?” –  (because we can’t trust them to run their own business…) You don’t understand Roy: It’s not where is it – it is what I do that matters.  It’s about continuity of care.
• We see symptoms, not diagnoses.
• Very elderly – maybe need a new model of holistic plus social care (and maybe get rid of poly pharmacy – every older person on 5 drugs max??? No need for medicines to counter side effects – how stupid is that?)
• There is no one size fits all.  Darzi (he never mentioned Poly Clinics…) may fit the London model, but elsewhere? (Two NHS’s – London and the rest of England / UK?)
• “What about just moving you all to A&E?” Research shows you become an A&E consultant – over investigating, because it is there.  Not Family Doctor anymore…and we feel that is still the essential
• More hospital specialists and other experts (e.g. Specialist Nurses in Diabetes and Stoma, as examples that already happen – just stop calling them outreach clinics.  Your expert is her in the building!)
• No GP surgeries are in special measures – fact (whatever Daily Mail would have us believe)
• Health services around the world are unaffordable without being GP led
• We need to take away some of the perverse incentives of some targets

More heat than light?  More questions than answers?  For sure.  But maybe one of the things that needs to change is the attitude towards change.  For example, we do need to have access to our own data (Look, everyone who was there last night is also a potential patient.  Don’t you want to know your own data? And not to have to convince a receptionist that you should have access because you may know more than your generalist GP (it’s in the title) knows, if, for example, you are a Biochemist?)

Claire said something fundamental early on. “There is nothing so beautiful as going to visit a dying patient in their home. I am a generalist not a specialist. I want to see and help the sore throats the depressions and the like. And to see the dying patient.”

Holistically and psychologically, everyone wins in that close encounter. The bean counters may say “someone else should do that, not good use of your skills”. I’m sorry. It is. For the dying person. For their family and friends, and for the GP. I don’t care what it looks like. I want it to feel like Claire described.

I have had panicky e mails – Izzy the time Share Dog does not have a front leg missing – she was just moving very fast!

PROOF!  And she is very curious:

…sniff…

What I Learnt Yesterday is my Twitter stream which I produce daily at 08:15 (it was going to be 20:15 to align with the year, but more people look at their Twitter at 08:15 than 20:15 – so it’s as near as I can get!)

It has been quite challenging – hitting 08:15 precisely – Twitter doesn’t like pre-publishing drafts to just pop out at  a certain time – otherwise advertisers would swamp the network). So I am trying, and it will be as near as I can get.

There will only be one picture from last week at the bottom of the post. It was Thursday’s tweet. You will know what it was about already.

If you didn’t catch them all – they were as eclectic as week 1 (I am learning a lot about myself!).

1. No FA Cupsets – lovely word for when a lower league team achieves a giant killing act.  It was close in some.  It is gladiatorial in sport – and lower league performers can succeed. Think of new upstarts or a new competitor?  See – the metaphor does transfer from sport?  Metaphor / analogy is one of the best ways of gleaning your own bit of learning each day you are on this earth.
2. I got a bit exercised by the start of an election campaign in the UK. I suppose we always knew with the advent of a coalition and  fixed term parliaments, that we would suddenly become quasi american and have much longer campaigns.  I already hate the narcissistic negativity.  No-one is saying what they would do.  Only what the others would screw up.  How damned annoying is that?  And they, the Westminster Elite, wonder why we are disengaged?  Perhaps a box saying ‘none of the above’, and if that was the winner, then there would be no MP for that constituency? And don’t get me started on lack of democracy – in safe seats, your dissenting voice will have no effect.  That is not democratic.
3. It was strange getting going after a couple of weeks off – as much for me as for my colleagues and clients.  No-one was contactable on Monday.  By Thursday, everyone wanted to chat!
4. My big learning this week was in one day with client meetings.  Mainly to do with managing performance – and how to create a high performing team. Praise and improvement was a simple concept we chatted about.  This fits for the sporting links too.  It is much easier to add to what is going well than to try to turnaround something that is going badly.  Build on the positives (Politicians – I don’t expect you to listen.  But you should do this too.  Or shut up).  But if performance is bad?  Sometimes, we have to forget coaching and an inclusive approach.  Tell is the direct way:  3 E‘s -model for improvement:  Give an Example of the behaviour or input that needs to change;  Tell the person the Effect it is having on you, other people in the organisation, or the processes;  tell them your Expectation going ahead of here.  Then, (and only then) ask them what actions they will take to make that happen.  No discussion – just tell it as it is.  Powerful stuff…it works.  The final quote was Privilege or Entitlement?  Some staff get spoilt in good organisations, and take advantage.  You do have to remind people that they are getting that piece of slack, that bonus, that support as a privilege – it is not just a baseline entitlement.  If they abuse the privilege them they should lose it.

Finally, after Paris, I published just a photo I took on Thursday morning, at my desk.  I don’t draw.  I love the way cartoonists help us to make sense of the senseless.  But here it is.  #JeSuisCharlie

Ok – it was a short week – but i did learn a lot last week!  The discipline of producing a tweet a day – especially when on holidays – is enlightening, frightening and creates great creativity!  You can do some auto production stuff on Twitter, but I have decided to produce the thing at 08:15 every day (see last blog for more explanation, if needed.)

(If you want to follow me at 08:15 every day this year (eeek!) I am on Twitter as @canmencook )

Last week was just a bit eclectic. I had decided to just go for it – and for those who saw – there were lots more than 5 tweets (felt the need to start big on 1st Jan!).

If you didn’t catch them – here’s the themes!

• I can still cook without GnT (dry January)
• You can operate on a Goldfish (who knew?)
• Rik Mayal tribute on BBC 2 was sobering – he was younger than me, and was an anarchic genius)
• Starting to follow someone new on twitter is great – e.g. try @herdyshepherd1 –
• It was scary even thinking about the 364 days ahead…

The biggest learning though was being away for New Year at Carlyon Bay Hotel .  It was hard to fault it and provided a lot of food for thought (as well as a lot of food…7 course new Years dinner made breakfast quite difficult…)

(That’s the view from the roof – and the way our windows faced too!)

Why was it good?

1. There were a lot of attentive, smiling, involved staff (Following Richard Branson’s Virgin model – if you have enough of the right people then the service will be better)
2. The whole thing was orchestrated and organised.  Pre- and post dinner for cabaret band?  You had an allocated seat, so no ‘towels over sun lounger’ type situations
3. If anything went wrong it was sorted. New person doing things slowly? Two management supervisors sidle in silently and smooth things over – almost impossible to notice.  Same new person got an order incorrect?  Meal taken away and correct one arrived within 45 seconds.  Just amazing.

I’m sure the essence of Hotel success is just this.  Getting the right people, training them well, supervising well, having a hands on style, and only employing like minded people who ‘get it’.  They all were courteous, smiley, enjoyed banter between themselves, worked hard and just looked like they enjoyed it with you.  Most hotel stays are pretty OK or good.

This was excellent.  The setting helps – but the people made it.