The practice leaders programme was conceived early last year by the primary care task force of NHS Education South Central.
The brief was to facilitate primary care service improvement through an educational initiative to be established in two centres, one in the Wessex Deanery and one in the Oxford Deanery.
The sites chosen were Portsmouth and Milton Keynes - the two areas across the South Central strategic health authority patch with the highest levels of deprivation. It was envisaged this would be where frontline staff may most appreciate the support of the programme and where the health gain may be greatest for service improvement.
In response, the appointed programme directors (myself and Marion Lynch for Milton Keynes) designed, developed and (with thanks to their faculty colleagues) have recently seen to completion a successful first year of the practice leaders programme.
The programme ran for eight months and was delivered in three terms of eight weeks. A total of 30 participants took part.
The three core design principles of the programme have been that it should release talent, develop leadership and deliver service improvement. Our reasoning was that firstly, we recognised that frontline staff often feel the demands of their work weigh heavily, while receiving little recognition for it, so leading to a lack of belief in the considerable skills they are using on a daily basis.
To counter this, and inspire the participants to think about the possibilities and opportunities of service improvement work, we helped them recognise and so ‘release’ their talents; continuing to support their professional development throughout the programme.
Teaching was provided throughout the first term to help them explore and develop their leadership, helping them see that effective leadership would be a requirement for enabling the changes that would be needed if service improvement was to be successfully introduced in their workplace.
Core knowledge to enable them to ‘deliver’ service improvement was introduced. This included lean approaches, systems thinking and patient engagement. The subsequent support for each participant’s project work was provided in term two by action learning sets.
Term three allowed time for projects to be completed, written up and presented.
The first year’s programme has been for GPs. This was deliberate as 10 newly qualified general practitioners were recruited to the programme (each working between two practices) to both participate and to provide back fill at their practices to enable mid career colleagues from those practices to join the programme.
However, the presence of a practice business manager in the Portsmouth group was widely recognised to have enhanced the understanding of the whole group regards issues that would not otherwise have been considered.
A formal evaluation of the programme is underway, but it is clear from both enthusiastic term-time session evaluations and the delivery by every participant of an effective service improvement project that the programme has been a success.
Some highlights include: the implementation of a phlebotomy service as a first stage towards the implementation of an integrated chronic disease clinic service; the introduction in response to asthma patients’ requests of personal asthma management action plans; and at another practice the redesign of the x ray pathway simplifying it and better informing patients of the steps to follow from the initial request and purpose of the test, through to their receipt of the result.
The programme is set to commence a second year following a successful bid for funding. The desire now is to seek participants from the wider primary care workforce such as practice managers, practice nurses and health visitors.
It is hoped that if the programme continues to prove its effectiveness it may become an established educational approach that supports primary care service improvement just as it was conceived to do.
As the frontline staff service improvement know-how the programme delivers supports all the objectives of government policy on practice based commissioning, world class commissioning and Darzi’s desire to see leadership development, it may be a very timely initiative.
Richard Mann is programme director (Portsmouth), practice leaders programme, primary care task force, NHS Education South Central,firstname.lastname@example.org