Training Primary Care - NHS - GPs - Rise and Fall of Strategic Planning

Regular readers know, I avoid sporting metaphors. They are not for everyone but last weekend was a very good example of management in a modern format.

The Rugby; the tactics and techniques that created the explosive first half and the change in tempo for the second half.

The Grand Prix; how the decisions made off the track played as much a part of the win, as the decisions made by the drivers.

Decisions made in the ‘now’, using data. Nimble decisions, reflecting the what… not the maybe.

Strategy versus tactics and techniques.

The NHS still uses strategic planning, like it did in the 60’s.

Strategic plans lack dynamism, they don’t tell stories, they are pages of guff that defy engagement from all but the anoraks.

Plans that claim to define the work and the future for thousands… read by a mere handful.

By the time an organisation realises it has a problem and decides to develop a strategy the problem becomes a situation. By the time the strategy is consulted on, finessed and published the situation is critical and the plan is obsolete.

The word strategic cannot be used without its partner word ‘plan’ and taken together they are little more than comfort blankets for spooked bosses.

They’re all the same;

Four parts. Up-sum of the problem, lofty vision, list of initiatives, five year forecast.

Our biggest problem is workforce planning. The failure to plan, squarely HEE’s. The sooner they go the way of the TDA, the better. It is impossible for them to recover ministerial confidence or the respect of service leaders.

The future of workforce planning is now out of their hands. A People Plan is being written.

Who is it for?

Ministers? There are no ministers interested, they are occupied with other matters.

The Treasury? They will have no interest in providing the NHS with more money.

The Trusts? No, they have no power to recruit students to university, no money to pay for placements and no influence over what a modern curricular or teaching methods should look like. Key issues, outside their control

Is it for the public… they’re paying for it. I think we know the answer.

Who will read it? People like me, journalists and think-tankers. We’ll pick it apart.

It will be the product careful modelling in pursuit of a perfect solution. It will be for five years because 5 is a strategic number .

No matter that there is an election coming. No matter that NHS planning is hand-to-mouth, rarely committing for more than one year. Years two, to five, are smoke and mirrors… an impression.

Henry Mitzberg, in ’78, defined deliberate strategy, which is intentional and emergent-strategy, which is not based on the original intention (in our example recruit more people), but a response to unanticipated events. For us, austerity, political chaos, Brexit, failure of lead organisations…

That is why tactics and techniques should replaced strategy.

Here’s the reality;

  • Medical and clinical careers are becoming less popular among the millennium generation who want a job and a life.
  • There are lots of choices for bright people.
  • Training based on models, grounded in the 80’s, takes too long.
  • Work-life experiences that are more based on slavery than enjoying work and life.
  • Communications that ignore the fact that social media has been invented.

A tactical workforce plan needs to do six things.

  1. A simple statement of the key choices we can make to influence the decision of more people to work with us and stay working with us.
  2. Send the right signals. Removing HEE from decision making sends the signal we won’t make the same mistake twice and we are serious about the future.
  3. A sleeves-rolled-up review of work; who does it and how and where they need to be trained. Degrees no longer mean university.
  4. Planning is a bet, remove the gamble. We try to shorten the odds by predicting the future and we can’t. The solution is in nimble; look for ideas, feedback, respond to events and unambiguous communication with the actual employers.
  5. Planning logic... make sure planning assumptions make sense. If the objective is to hire people and keep them… talk to the people and write about them their language.
  6. A controlled sense of urgency and accountability… to get it done.

The NHS is not rugby, nor motor racing but we are in a competition to hire the best people and turn them into winners.

Reproduced at by kind permission of Roy Lilley.