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.

You do know that phrase -“Everyday’s a school-day…”.  Yes?  It dovetails nicely into “When you have stopped learning you’ve stopped living…”.  And we all know people with 20 years experience – but they have actually only 1 year that they have repeated 20 times…

So, I’m setting myself an enormous task for next year.  A tweet a day – under a hashtag i have used already –  #WILY – What I Learnt Yesterday. It will be published at 8.15 everyday.  This is 12 hours earlier than 20:15, my elision time for the year (2015 – geddit???!).  There will be a weekly summary blog – What I Learnt Last Week – expanding on the themes.  And I will publish WILY early 2016, as a collected works book (physical and maybe electronic too…although I get rather tired of Amazon – somehow, can’t really trust them fully, what with their tax scheming mentality…)

Phil not looking worried enough yet….

Wish me luck – and I will be grateful for your own WILY’s as the year goes on – I may need the inspiration.

Today’s WILY?  The early bird catches the early bird – we did our food shop at 6:45 yesterday morning, and home and hosed at 7.30.  (Not all of the WILYs will annoy my audience….sorry if you are still out there shopping!)

Tim Kelsey is NHS England’s Director for Patients and Information.  A daunting title and brief, if ever there was one.  We were at The Kings Fund last night to enjoy one of Roy Lilley’s Health Chats.

(A point of conscience here.  Father Christmas visited at the end of the chat, and I was given a small bottle of Penderyn Whisky (award winning Welsh (yes) whisky, which was rather nice.  This in no way influenced my blog…)

Roy is one of the worlds best interviewers…(ok – I can stop now, any extra needs more bribery…)

Roy & Tim – afterwards, still friends!

Seriously, the chats do get under the skin.  Every one I have attended has given us the back story to the person who is siting being grilled and toasted by Roy.  It works, because what always floods out at some point is  both why they have achieved their position, and what created that passion in the first place.  And there is always a formative lesson or two in the background.

As an aside, we did have a technology input last night.  Helen Cherry is a deaf health professional was accompanied by a Stenographer, Orla Pearson who is a registered Speech-to-text reporter.  (see their web-site – www.mycleartext.com ). As Orla told me afterwards, one in 3 (wow) over 40’s will have some hearing impairment. One in 7 of the population have some hearing loss.

It was fascinating sitting two rows behind, and seeing the text come up on the lap top about one tenth of a second (literally) behind the interview.  If I missed anything, I found myself looking at the screen – it was that good and fast.  Even at the end when I chatted to the person with the disability (who was lip reading, but some things don’t work – like ‘sherry’ – talking about whisky again!) – so Orla just went back to her steno-graph (yes, like you’ve seen in Rumpole of the Bailey) and carried on.  There is always a way, isn’t there?  Fascinating, fantastic and a bit humbling.

The passion made it quite hard to transcribe at one point Tim spoke at 330 words per minute.  Here’s some of the highlights – as always, biased by my biases, not reportage (this is a cop out for me, Tim – as someone not journalist trained, unlike yourself…)

• The time line is very ambitious.  By next April, you will be able to access your GP on line record.  You will be able to add, but not edit their side
• 2018 – all Primary, Emergency and Urgent records will be available
• Opt in versus opt out – going for opt in, otherwise uptake will be too low?
• We spend a lot of the health spend on information and allied technology – about 4 or 5% – and need to sweat those assets more
• We have to be sure there is never a compromising of the privacy of the data. (As an aside: when the Royal Mail was privatised, the private data on postcodes and who is where and what they do (I think) was sold too – despite Tim saying it shouldn’t.  It worries me that the privatization of some NHS services could make this data accessible dressed and disguised the grey area of research??)
• (Tim said the law has been changed to make it illegal to attempt to re-identify anonymised data (not sodomised, as Roy said on Radio 5 Live…)
• Our legacy systems – despite everything that has and hasn’t happened in NHS It projects – amke us the most advanced nation, digitally, in the world.  Who knew?

My favourtite quote was from Roy:  “His legacy is your dichotomy” No idea who he was talking about, but don’t you wish you had said that?

And last line to Tim: centred on Genomics, but applicable to his whole remit, I think:

“We are talking the future of mankind here.  With better data – getting the ethics and governance right – it is so important or we will be denying a better future to ourselves and our children”

Passion and vision.  You can’t fake that.  Thanks, both of you.

My good friend Peter Cook (not the dead comedian, the M.D. Human Dynamics / The Academy of Rock – Speaker, Author, Facilitator : Strategy; Innovation; Creativity; Leadership – that one – wrote a blog on LinkedIn recently.  I thought it served many appropriate lessons for organisational life…and ‘honesty’ is one of my deeply held convictions – almost too big a hot button, such that I only give people one chance (which isn’t fair, but life is too short!).  I also love his humourously angry pictures.  Lets hope his ceiling is fixed soon!

read on….

Q : Should you lie in order to secure an insurance claim?

I was shocked and surprised to learn that my buildings insurance did not cover the sudden and dramatic collapse of the living room ceiling, having recently reviewed and upgraded the cover to what I believed was a good level. When I called Kwik Fit Insurance (The Agent) and Towergate (The Insurance Company), I was even more surprised when the interview commenced with questions about whether I had a criminal record! Just for the record, I don’t have a criminal record, other than a couple of songs by the Fun Loving Criminals and I don’t think this was behind their question. Neither have I ever made an insurance claim in my life. For many years I also had Professional Liability Insurance with Towergate. In short I thought I was a good customer.

Q : Should you assume that all your customers are criminals?

I’d imagine that asking you if you are a criminal is not the first question you would ask on a hot dinner date, so why commence the dialogue in this way? I had really expected something more like “Was anyone injured?” before moving on to ask “if I had taken the ceiling down myself so that I could sell it down the market” and so on. I’m afraid this got things off to a bad start which then got worse in subsequent communications:

“Well darling, before we begin, do you have any convictions?”

Towergate’s Debt Ceiling is approaching £1 bn – is it any wonder that they don’t want to honour claims?

The ceiling fell down with just a few minutes notice and we narrowly missed being under it. As soon as my wife spotted a crack in the cornice one evening, we removed all the items from the room and put sheets down to protect the carpets, but 5 minutes later there was an almighty crash. To my surprise from conversations with the insurers, it seems that this was the wrong thing to do. Apparently we should have left all the furnishings and valuables under the ceiling and claimed for the lot. Moreover, it seems that I was supposed to invent a tragic accident, where water had been spilled upstairs or some other single event that “caused” the collapse. Because I told them that the ceiling fell down due to “gravity” they told me that they considered this “wear and tear”. It seems that I would have been better to suggest that Lionel Ritchie had come round and caused the fall due to his insistence on “Dancing on the Ceiling” all night long …

Q : Hello, is it me you’re looking for? :

Don’t have Lionel Ritchie round for tea if you value your ceilings…

I remain indignant with Towergate insurance and Kwik Fit over this matter. Since I refused to lie about the claim, do not have a criminal record and attempted to minimise damage to my property to save claiming, it looks as though they will not support my claim.

You may well be thinking “Well surely you should have looked at the terms and conditions” and you are right. Yet, these do not talk about exclusions in older buildings. On further investigation, it seems there are a lot of people being caught out in similar circumstances. 61% of the UK population are unaware that their ceilings are not considered part of their buildings insurance if they fall down with no catastrophic single cause. I would argue that the insurance industry likes it this way as they never have to pay a claim. There is also a missed opportunity to sell additional insurance on older properties where a ceiling collapse is a much more probable event. Most houses built before 1940 are constructed with Lath and Plaster ceilings and are at risk of collapse at some stage as the ceilings dry out with hotter summers and so on.

Q : If the majority of the population believe ceilings are covered by buildings insurance, has the insurance industry failed to communicate this issue?

I doubt I will get any assistance in restoring my ceiling from Towergate insurance or Kwik Fit who handle the policy. I remain resentful that they would have preferred me to lie in order to make a claim. An insurance insider commented to the effect that the industry has good reason to mistrust the public, which seems to confirm that there is a massive communications issue to be managed here: