We are all aware that the practice workload balance is already, or about to, tip over and with this in mind, it is more important than ever to regularly take stock, check in on our colleagues, proactively plan ahead, take our leave (even if it’s not necessarily when we want to!), and if need be, reach out to others for support. With this in mind, our ever-popular Practice Index Practice Manager panel return to the podcast this week and are joined by GP, executive coach, and resilience expert Dr Rachel Morris to dissect and discuss a situation of which unfortunately many of us are more and more likely to identify with, where a GP partner has been forced to cancel leave due to a mixture of demand and a lack of locum availability. How can we avoid the same fate and how do we start to build resilience whilst most of us are feeling very much like we are close to the same level of vulnerability?

Introduction (33 secs)

Sourcing locums from a practice manager’s perspective (1 min 14 secs)

The situation in Kay’s area in Manchester (1 min 55 secs)

How have we got to a situation where locums are in such high demand? (2 mins 25 secs)

Facing the reality of having to cancel annual leave (3 mins 26 secs)

Working out what you’re in control of and what you’re not (4 mins 29 secs)

Planning leave, proactive rota management and the role of the practice manager (6 mins 21 secs)

Sustainability in a smaller practice (7 mins 31 secs)

Building resilience in larger practices (8 mins 21 secs)

Acknowledging our vulnerabilities and planning for them (9 mins 7 secs)

Added pressure as a GP partner (10 mins 8 secs)

Protecting the workload (10 mins 37 secs)

Support for the wider workforce (11 mins 9 secs)

Collaboration and co-dependence (12 mins 7 secs)

Working out where you can influence and what you can change (13 mins 58 secs)

Why asking for help is not a sign of weakness (15 mins 8 secs)

Buddy practices and increased reliance on others (16 mins 15 secs)

Managing the dearth of GPs and developing practice skill mix (17 mins 26 secs)

Effective communications (18 mins 50 secs)

An analogy of managing patient demand (19 mins 40 secs)

Making the most of the ARRS funding (20 mins 50 secs)

Time management and maximising impact (21 mins 50 secs)

Staff wellbeing is paramount (23 mins 8 secs)

Final thoughts from Robyn and Kay (23 mins 33 secs)

Rachel’s incredibly popular ‘You are not a frog’ podcast can be found here

For all enquiries about the Practice Index / Ockham podcast, please contact James Dillon here or Ben Gowland here

In another episode documenting general practice preparations for integrated care, we welcome back Dr Jon Griffiths, GP Advisor for Cheshire and Merseyside Health and Care Partnership, NHS North West Leadership Academy board member, RCGP Mersey Faculty Board deputy council rep and Cheshire LMC member. As part of his GP Advisor role, Jon has worked with colleagues across Cheshire and Merseyside to produce a consensus document focused on the Primary and Secondary Care Interface and improving cohesion and clinical pathways between these two key areas of healthcare. Based on a set of guiding principles and with the aim of establishing a common architecture of good quality, patient-centred communication within the new integrated care systems, Jon talks to Ben about the input from both primary and secondary care, striking a balance between meeting the needs of the wider system and more local requirements, and the key milestones for both sectors when embedding a truly successful system of integrated care.

What is Jonathan’s role and remit right now? (23 secs)

Responsibilities of the ICS GP Advisor (59 secs)

Myth-busting (3 mins 41 secs)

Primary Care views of secondary care (5 mins 25 secs)

Reaction from the secondary care consultants (8 mins 30 secs)

…and the secondary care ask of general practice (10 mins 45 secs)

Establishing mutual benefit (13 mins 14 secs)

Building consistency across primary care (14 mins 41 secs)

Where does the real opportunity for truly integrated care lie and how do we strike a balance between real-time need and the PCN DES requirements? (15 mins 31 secs)

What is needed to enable a strong and united primary and secondary care interface? (17 mins 7 secs)

Life after CCGs (19 mins 37 secs)

Strengthening GP representation (21 min 12 secs)

Accessing the consensus (22 mins 7 secs)

The Consensus document is available within the Cheshire and Merseyside Health and Care Partnership website here.

As ever, here at Ockham, we are fortunate to have been able to have taken some time out from business as usual to put our feet up and properly digest, review, and summarise the recent Fuller report publication on integrated Primary Care (and what this might look like in the context of the wider Integrated Care world). As with everything, our conclusions are our own and having spoken to our allies over at THC Primary Care, it’s clear that the report can be interpreted in many different ways, depending on who you are, where you sit, what your remit is and how prepared you may (or may not) be feeling ahead of the upcoming transition. In this week’s episode, Ben and THC Primary Care founder and MD, and PCN Management expert Tara Humphrey discuss their key takeaways from the stocktake and what they both feel general practice should be doing right now to ready themselves for integrated primary care, and ICSs beyond.

Introduction (9 secs)

Setting the scene…. our differing perspectives (19 secs)

Tara and Ben’s initial thoughts (29 secs)

What’s missing? (45 secs)

Ben’s concerns (1 min 17 secs)

What would Ben liked to have seen within the report? (2 mins 54 secs)

Shaping the debate (4 mins 46 secs)

A threat to the PCN model as we know it? (5 mins 52 secs)

Tara’s views and getting the most out of a larger network infrastructure (8 mins 3 secs)

Readying general practice, as it stands (9 mins 21 secs)

Acknowledgement of existing constraints and what this means going into an ICS environment (9 mins 58 secs)

Do the recommendations within the report pose a risk to the PCN management structure? (11 mins 6 secs)

General Practice influence at an ICS level (12 mins 44 secs)

The importance of a united primary care voice (14 mins 27 secs)

Time pressures and maintaining influence as a GP leader (15 mins 15 secs)

What should we be doing right now in preparation? (16 mins 55 secs)

Tara’s predictions ahead of the transition (17 mins 47 secs)

Recommendations from Ben (18 mins 53 secs)

Tara advises (19 mins 53 secs)

Navigation of bureaucracy versus responsive decision-making (20 mins 43 secs)

We need you! (21 mins 45 secs)

Next steps for integrating primary care: Fuller stocktake report (final report) is available here.

There is still plenty to discuss where the report is concerned and absolutely no way to cover it all this 22-minute podcast instalment. We are keen to hear views and even better, feature representatives from across general practice on the podcast to discuss the transition into the integrated care, what this feels like from your part of the world and your own take on the Fuller Report. So if you (or your team) are interested in taking part, please contact Ben at ben@ockham.healthcare or get in touch via Twitter.

We are in full countdown to ICS mode here on the podcast and in recognition of the existing issues of workload, pressures, and targets - and of the upcoming challenges General Practice is facing as we transition into the new, larger scale networks, we felt it was about time we welcomed back Dr Rachel Morris, GP, executive trainer, coach and all-round leadership and resilience expert. This week’s podcast offers a wealth of practical advice and insight into how and why we should be saying no, how to stick to your guns (and not fall victim to external pressures and pushback), why a long-term approach will always win out and how to stop, take stock and adopt a more strategic forward view during this period of high stress, unpredictability and unprecedented levels of patient demand.

Introduction (9 secs)

Why has the importance of saying “no” become so relevant recently? (19 secs)

Working out what and where your boundaries are (2 mins 6 secs)

Engagement and decision making when setting boundaries (2 mins 41 secs)

Should we benchmark the PCN DES?  (3 mins 12 secs)

A case in point: Investment and Impact Fund (3 mins 50 secs)

Identifying our top priorities? (4 mins 27 secs)

What is achievable and what’s not? Managing system pressures (5 mins 42 secs)

Practical measures for dealing with pushback (7 mins 11 secs)

Pressures of conformity in the new world? (8 mins 53 secs)

The importance of taking a long-term approach (10 mins 59 secs)

Moving from firefighting to forward view (11 mins 54 secs)

Applying the same principles for the Additional Roles Reimbursement Scheme (12 mins 56 secs)

When ARRS strategies fail and why (14 mins 6 secs)

“I’m choosing to…..so that…..” (15 mins 12 secs)

Maintaining a strong narrative (15 mins 34 secs)

Do the same strategies work from an individual perspective? (16 mins 9 secs)

The concept of ‘air cover’ and truly having each other’s backs (17 mins 45 secs)

Why proactive engagement matters (19 mins 1 secs)

….and ensuring there is accountability (20 mins 13 secs)

Finding out more / access to resources (21 mins 32 secs)

You can access the free mini video series on helping your team to set boundaries, say “no” powerfully and prioritise time and energy here

Rachel’s incredibly popular ‘You are not a frog’ podcast can be found here