PCTs’ plans for the tough times ahead need both the right ‘anatomy’ and ‘physiology’

Just nine months from now, primary care trusts are expecting to receive financial allocations with growth much closer to inflation than we have ever seen before. What should they and their trust colleagues be doing to prepare for these straitened times?

The plans they develop and implement must have two dimensions of equal importance.

The first I will call the “anatomy” of the plan. This includes the hard-edged essential mechanics of the programme. It will involve the right coalition of leaders, managers, clinicians and public representatives systematically identifying the major opportunities for cost and quality improvement. They will prioritise their improvement efforts to deliver these benefits and determine the necessary milestones and outcomes. Crucially they will agree how to execute these plans well and track the benefits in quality and in cost terms.

We have to accept that the service has not always done these things well - but tools are available. These start with a range of “opportunity analysis” tools to highlight potential areas for improvement. There are many examples of successful programmes that have delivered cost and quality improvements, but have not been sufficiently widely adopted.

And there is a growing database of successful approaches that have been judged to meet fairly stringent hurdles for inclusion that point to interventions that should be considered.

Finally there are a number of tools to support execution that have been developed with NHS staff and fit the culture and the language of the service. Organisations like the NHS Institute for Innovation and Improvement, NHS Improvement and NHS Evidence, among others, have a suite of support to offer, but nothing can be a substitute for local leadership.

Many of the most significant opportunities will be realised where organisations serving the same population commit to working together. Of course, some of the major programmes to deliver productivity opportunities will take longer to develop and to agree; they may be contentious between organisations and may be challenging for professionals and with the public. All the more reason to push ahead with a programme of smaller but significant improvements that can build momentum and get close to the curve of improvement necessary while the more complex planning and negotiation is going on.

Show of commitment

But just as important as the “anatomy” of these plans is the “physiology”, by which I mean a purposeful process of building energy, engagement and commitment for the delivery of these plans. This means a leadership community who are reaching out to the clinical workforce and to the public with a narrative that is honest about the scales of the challenge and the opportunity.

It means leaders engaged in demonstrating their own commitment to improving and protecting quality. A group who show that they recognise that some of the answers - in fact most - will come from the “ward room” not the boardroom.

These leaders will frame the nature of the challenge in a way that people can connect with. A £20bn improvement in productivity is unimaginable to most of us. An alternative description - for example, that a ward manager with their team needs to propose ways of releasing £100,000 per year of value for their patients, some of which will need to be diverted to buy new drugs or different services - seems more comprehensible.

Or that a combination of specific programmes will release 35,000 bed days of capacity; or that a community team can increase their patient caseload by a fifth through deploying productive community services. And that in each instance there are clear cut improvements in patient outcomes and safety as well as the financial benefits.

A group led by my colleague Helen Bevan has distilled the evidence from many sectors’ efforts in creating and delivering such a major change into a framework that might prove valuable in approaching this part of the task.

All this means that, as leaders, we will be demonstrating that we can play our part in liberating the innovation and the commitment of our staff and harnessing the creative contribution of our service users, very much in line with the early messages from the new government. All of this should be communicated with honesty, with urgency and with a sense of optimism that our staff can be relied upon to find the answers to the questions posed by these circumstances.

Every vital organism needs a fully functioning anatomy and a well modulated physiology. So do our vital plans. If we want to play our part in delivering the NHS we love through the most challenging period in its history, now is the time.