Highlights of the Week 14th March 2014

I try not to celebrate Fridays; it makes me feel like I only exist for the weekend, when in reality I like to focus on the enjoyment of the whole of the way I choose to balance home and work as aspects that make up my life.  But I am tired this week, so it will be good to relax a bit (although there is a large shed that I need to erect that will test the relaxation piece!) 

I am also four weeks from a holiday and I have been invested in that thinking about how great that will be as a colleague was describing their journey to the airport tomorrow morning.  I do think that anticipation is one of the best parts of holidays.

The five highlights this week on Twitter (@jeclo)

Highlights of the Week 1: GP Members’ Forum-an engaged debate about referral management shows practices are interested in the CCG

It was an interesting day.  We run a forum for the 53 practices in the Western Locality of the CCG every quarter and we get a representative regularly now from over 80% of practices.  We probably had more of a challenge around engagement than the other Localities in the CCG: Northern has a tighter group of just over 20 practices that have worked well together and there are 4 clear sub localities in Eastern that promote really effective engagement.

So we’re always checking whether we get good enough engagement or not and the Members’ Forum is a barometer of that.

This week was a good day.  We run the same event twice – morning and afternoon so that we don’t shut practices, don’t use up all the locums available by trying to get everyone there at once and to give us a good group size to some of the breakout sessions and stalls and stands that we put on.

We did a presentation about our 5-year strategy and our commissioning intentions, but the real engagement, which could be a euphemism for a bit of angst, was around referral management.  The CCG has brought together two really good centres in Plymouth and Devon that have worked slightly differently under one management structure.  Clearly GPs locally are worried about losing what they see as the special character of our local centre.

I love the debate.  We could have done better on the engagement and communication, but the process is sound and involves the Locality Boards and Governing Body making decisions on behalf of their members and in the best interests of patients first and foremost.  But the discussion was exactly what we need to ensure that the Members are not passive about the CCG and our decisions.

Highlights of the Week 2: Working with the Clinical Leadership Group on the next version of the 5-year strategy. Increasing alignment and focus

We have processed the feedback on the first submission of our 5-year strategy and the job on Wednesday morning was to work with the Locality Chairs, Vice Chairs and CCG Chair to improve the description of the kind of system we are trying to create, the challenges we face, the impact on our provision landscape and the way it will feel for patients.

We have 5 key pillars in our strategy

Partnerships to improve health and wellbeing

Integration and Personalisation

General Practice as the organising unit of care

A regulated system of efficient and effective elective care

A safe and efficient urgent care system

It was really interesting to hear everyone’s take on what those pillars stand for and how the NHS would look different as a result.  There is no doubt that the work on integration is top of the pile for us – we are really commited to transforming how health and social care work together, but we also are looking at vertical integration in some parts of our system.

The Clinical Leads group brings together GPs from very different areas and we are addressing some of the real issues for our economy about health inequalities, demography and our ageing population and the need to support local access. It feels like a very positive and purposeful discussion, against a very challenging backdrop.

Highlights of the Week 3: An evening with the CCG Leadership Team to think about how we model our values for our staff.  All of us, all the time

There is a deep irony that we finished an evening of dinner and discussion at 10.30 when one of the main issues for discussion was how we model our values and one of the keenest areas of debate was whether it is ok to be emailing at 10pm – is that the example we want to set for staff?

However, giving up time in a social atmosphere to think about those issues didn’t feel like the kind of work we should be worrying about.

I am passionate about the issue “Leadership by example is not one form of leadership, it is the only form of leadership”.  I buy that.  So I don’t send emails after 6.30pm, before 7.30 or at weekends.  I try not to work in those spaces too, but that is less easy.  Is it ok that I work in the evening, but don’t let others know?  Or is that deception?

I think that managing the impact is important, so if I work because that is a choice I freely make (and for me it is unusual, I prefer to work at a fearsome pace during the day/ week to keep on top of emails and tasks than to work at weekends), but protect others from the impact of that or what may feel like a demand for them to do the same, I think the intent is positive.

I tell people at work and they know that in an emergency they can text or phone me, but I won’t respond to emails.  I hear it back from many people, so the example must be having an impact, positively, on our leadership style (one person said “I hear you delete all emails you get after 6pm – not true, but I quite like the idea that people might think that!)

Highlights of the Week 4: Spending time with one of our Locality Chairs to explore the many areas we align on, rather than the few differences

I sometimes clash with one of our Locality Chairs.  I love fluffy development, time to explore values, behaviours and patterns; he prefers for development to be business focussed and to be “real”.  The development of mission and vision and consideration of whether a vision needs to be a purpose you own or could be aspirational was one area where we sparred a bit recently.

However, we both truly value the other’s contribution and skills so we agreed to sit down this week and work through how to represent the organisation on one side of A4 in a way that we both likeed and felt that the Board and staff would be happy to align behind.  All brought about by the fact that I like this from Plymouth City Council which is up in all their buildings, including in every meeting room where I work. Not flash, just simple, clear and often repeated.

It was a great hour, full of aligning behind what we are trying to achieve and finding out – from resource allocation to referral rates, just how much we agree on.  Time to find more time to do this more often.

Highlights of the Week 5: The emerging strength of the Commissioning Managing Directors meeting. A large CCG needs four localities with one aim

We designed a CCG with over 900,000 population around four commissioning localities and a partnerships Directorate that commissions scale services CCG wide.  So our bottom up design looks like it builds from those four key components.

Increasingly those it is obvious that we need to and do operate as one CCG with local community focus, ownership and accountability.  Our commissioning intentions and strategy are based on all areas working collectively then working out what that means in each local area; last year our commissioning plan was made by pulling four largely separate plans together.  We have made great progress – not easily, but increasingly with the commitment and energy from all parts of the organisation.

One of the key components of that collective effort now is the Commissioning Managing Directors’ Meeting every fortnight where the four of us have space and time to think through the challenges and to work our collective or individual responses, projects and actions.  In a Leadership Team with many issues to focus on and, at its heart, the job of overseeing the effectiveness of the CCG, we didn’t seem to get enough time or in an informal enough way to develop, enhance and improve our thinking.

So, today I finished Friday with a couple of hours sat with the MDs talking about the Better Care Fund, our 5-year strategy, the work on Challenged Health Communites, community contracts, the development of the Planning and Programme Office and a number of other things that came up.  Felt energising on a day that had signing off of paperwork for arbitration in the middle of the day.