Clinical leaders of primary care networks face both challenges and opportunities to bring people together to drive real change. Beccy Baird, Senior Fellow, and Tricia Boyle, Senior Consultant of Leadership and Organisational Development, at The King’s Fund, suggest five ways to help successfully lead a primary care network.
1,300 new primary care networks (PCNs) in England have now been created as a critical part of the long-term plan for the NHS. While some of these collaborations existed before the new PCN contract was introduced, most are new and many of the clinicians who have been appointed as part-time clinical directors to lead these new networks are new to a formal leadership role, and in particular to leading across organisations and within complex systems. The scale and complexity of the implementation and leadership challenge that faces them can’t be underestimated.
The question is then what support might these new organisations and leaders need? Drawing on our experience of working with structural and cultural changes and our current work with emerging PCNs, we offer five suggestions which we think will help these new networks succeed.
Develop a shared vision and direction
Co-producing an early vision with the local community will help form the ongoing purpose and a collective culture. The work of the PCN needs to be creative and bridge the gaps between government policy current service delivery and the needs of the communities they serve, and engaging others in the development of the vision to have a sense of ownership is probably the single most important task for clinical directors. Tapping into the views and expertise of existing patient groups, volunteers and health champions and finding allies for service change will make decision making much richer. Local councils and politicians are also important allies and can provide connections with the local community to really help PCNs engage with the people they serve.
Develop the skills to improve conversations
The most successful collaborations are underpinned by good relationships, and the capacity to really listen and talk openly, which can be surprisingly difficult to achieve. It is quite a discipline to put aside what you have always thought to be best practice and instead to enquire with others and really hear their perspectives, as well as share your own. Doing this will allow people to truly collaborate and be better able to bridge the gap between current practice and a future, more joined-up service.
We’re currently working with four primary care networks in Surrey and Sussex, commissioned by the sustainability and transformation partnership, exploring with them how to improve the quality of their conversations, thinking not just about getting to know colleagues, but how they’ll surface and resolve conflicts and develop new solutions to chronic service issues.
Find the allies in your system
The work of PCNs cannot be delivered alone – it requires concerted action by lots of different organisations, both within and outside of the traditional health care system. While the sheer scope might feel overwhelming, our research shows that starting small, with a concrete focus and growing relationships from there is really important, whether it’s with a small number of conversations with individuals or using existing networks to share challenges and test solutions. Moving towards a more collaborative approach requires a supporting language that can help explain what you are trying to do differently.
Set up small shared projects
Creating a successful PCN is of course a shared project in itself. However, within that, there will be lots of smaller projects that can be a starting point for people across the network to get involved in. These smaller projects will create connections, establish relationships and help to build confidence in others across the network. Everyone involved will learn how to navigate the complexity of having multiple organisations involved in the decision making.
Our work with the new integrated care systems has found that those PCNs that are furthest ahead are those that have given priority to strengthening collaborative relationships and trust, often achieved by establishing a common cause, spending time together and undertaking focused pieces of work with their leadership groups. Leaders who are able to model collaborative working can inspire others to do the same.
Find personal support
It can easily become a habit and then way of life to give support to others and avoid asking for or receiving support for oneself, but not seeking support can have more unintended consequences than is often realised. We can all underestimate what we don’t know and risk working without the knowledge of others. Finding the right support can help build the leadership expertise, skills and resilience needed to bridge the service delivery gap more quickly. This might include informal support from peers through mentoring, reversed mentoring or creating a learning set. It might also include more formal interventions like coaching for groups or for individuals, taught leadership skills development, or finding external facilitation to help with areas of known conflict.
NHS England and NHS Improvement have worked with stakeholders across the country, including the Fund, to develop a description of ‘good’ development support for regional and local teams to use. These teams will then be working to think about how to ensure PCNs in their area can access the development support they will need.