Two hundred…

training primary care NHS two hundred roy lilley jigsaw

We have a Long Term Plan, an Interim People Plan and a new GP contract. So, now

we’re clean clear to flag-town.

Err… well, let’s hope so.

There is the little issue of a new prime minister and the Gordian Knot that is a sensible, civilised withdrawal from our membership of the European Union. Or not..

And, a conversation to be had about the money. Will the Treasury fund the costs of the PP and the GPC? There is a rumour the spending review is likely to be delayed.

The economy is moving out of austerity and The Chancellor has a accumulated a tidy few quid. What would a new PM do?

I predict a splurge in public spending. Schools, police and social care, highly likely to be the beneficiaries and commitments to the NHS, kept… to soften us up before the inevitable… an election.

Political strategy is all about narrative, timing and bribery!

So, with the money and three nice new plans, we’re ok? No, we’re still missing something….

An integrated delivery plan.

Maybe, in a great mind somewhere at the top of the NHS management heap there is a view but down in the valleys, it’s hard to see.

In fashionable management circles the term ‘strategy’ is seen as a relic from The Geezer Butler school of management.

Now we have plans, interim plans, scenarios, tactics and techniques but in the grand scheme of things, call them what you like, we still have to do four things;

1. Make sure everyone has a clear understanding of what the plan is and what their bit is.

2. Find a way of making their bit actionable by the people actually doing the job.

3. Have clear implementing procedures that will keep all the action items aligned with the overall ambition.

4. Agree the priorities and a workable timeline that people already busy doing the day job, can cope with.

This is where the wheels start to come off. Of the four items, the forth one is the trickiest.

Doing the day job, delivering targets, regulation and staff shortages, push implementing anything new into the round-tuit box.

Big change is not a hobby, not to be done in management’s spare time.

I have no beef with the LTP, it’s deceptively clever. Neither, the IPP, it’s first-pass-practical. The GP contract… the GPs have won hands down, but they always do. Nothing new there.

What I’m worried about is what worried The Duchess when she was following her favourite pastime; gigantic jigsaw puzzles.

How does it all fit together? If you can’t see the picture on the box, you can’t see what you’re aiming for.

In management speak; where’s the integration coming from? How do we join all this, up?

How do we develop the cross-functional management approach that connects the people, the money, what we want to do and when?

How do we build the system processes, develop and probably change, stakeholder culture, find some practical, real-world leadership and the emotional intelligence that glues it all together and makes it work?

Integrating plans for digital, data, estates, systems, structures, people and finance… all aligned with the delivery stages and goals.

Will the People Plan deliver the Long Term Plan, will the Long Term Plan make the GP contract work, will the People Plan give us the GPs and new workers doing new things in the Long Term Plan and deliver the future?

It is a labyrinth; elaborate, confusing, a maze and a perturbation.

What would big business do?

It would appoint a well resourced delivery team, focus on three things and deliver them in a crisp, agreed timescale and move on to the next phase.

What does the NHS do?

Ask people, already up to their armpits in aggravation, pressures and targets, harassed by regulators and financial pressures, to deliver a hundred or more things in a web of conflicting timelines, all at once… and put up with No18’s latest fads and brainwaves along the way.

The two golden rules of managing for results; simplicity and focus… but, when did the NHS ever do two things when it can confuse us all with two hundred.

Have a good weekend.

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Reproduced at by kind permission of Roy Lilley.