Paul Maubach on the experience of being public about the work on the Dudley MCP and the importance of sharing know-how in the NHS
When we embarked on our journey to develop a multispecialty community provider in Dudley, in contrast to the way many sustainability and transformation plans have initially been developed, I made a conscious decision that we would be as public and transparent as possible about each phase of our development.
This felt like a difficult decision at the time: whilst we had a clear vision for our care model, we were only at the early stages of development. Despite working in the public sector, there was genuine trepidation about being too public about what we were doing – partly because there is a fear about how this will impact on us; but also because it almost seemed disingenuous to publish what we were doing when there was still so much to do.
In particular, by being public you offer others the opportunity to critique your work; or worse: you expose flaws or stresses and tensions in the work that you are doing.
It would be naive in the extreme to think that any change process, particularly one so significant as creating an MCP, could take place without very real challenges. And it is easier to stop a change than it is to continue to pursue it – so there is a genuine concern that by being public this could risk the whole programme of work itself.
However, I curbed these fears and have been public about our work for several reasons:
Firstly, it is a natural extension of the way we have been working in Dudley: the development of our MCP started with extensive local public engagement on reviewing the needs of our population, leading to the core underlying principles behind the design of our care model. This initial work gives us confidence and clarity in the benefits and strength of the model. And further publication of our work continues that engagement with the public.
You cannot expect the public to be more involved in their own care and shut them out from the development of that care
Secondly, it is part of the expectations of being in the new care models programme that we publish what we are doing in order to share learning with other parts of the NHS and social care system. By sharing our work this has both helped us to hone our own understanding of what works and what needs to improve; but it has also enabled us to engage with many other NHS organisations and similarly learn from the work they are doing.
It’s obvious really, but you can’t share your work with the NHS and keep it a secret from the public.
Most importantly, I believe that the MCP model represents a tremendous progression for our NHS. It does more than merely ensuring that General Practice is sustainable and fit for purpose – it redefines primary care as a fully extensive population health and wellbeing service that creates a multidisciplinary team approach to delivering care.
It enables us to deliver a more consistent care offer to our patients and it affords the best opportunity for us to meet, in the community, the changing needs of our population. That means an MCP will only work as a model of care if the public are fully involved in the provision of their own health and social care.
You cannot expect the public to be more involved in their own care and shut them out from the development of that care. Within an MCP the public are an integral part of their health and social care system.
Not including them in the development of that system is to condemn the system to failure. If we don’t engage then we don’t add to the shared understanding of how to improve our NHS for the better. So we have to be public about the work we are doing in order to participate in the discourse and debate about how to deliver the best possible care across our NHS.
Dealing with the tensions
In truth, being public at every stage has exposed the tensions and challenges in our work. And sometimes this is painful.
Working in this way has helped us to learn how to work with those tensions, rather than allow them to prevent progress
By presenting an open and plain view of our work and by doing so as events unfold, we have intentionally avoided a partial approach of just circulating good news case studies. And I hope this is testament to a non-defensive and empirically minded approach that we should all encourage.
If we believe that our NHS is all about our people: both the public we serve and our staff who deliver care to them; then we do a disservice to them by not constantly engaging publicly about what we are doing. And it turns out that working in this way has helped us to learn how to work with those tensions, rather than allow them to prevent progress; and it has fostered positive public engagement in helping us to continuously refine our care model.
We haven’t worked out all the answers in Dudley; and we still have a very long way to go to fully realise the potential of the MCP model; but we are definitely more successful as a result of regularly publishing our work.
So in my experience, the more of us who publish what we are doing, the more we can point to a shared understanding of what is in the best interests of our population; and the more we can help each other to succeed.
Paul Maubach, chief executive officer, Dudley Clinical Commissioning Group