Professionalism and Excellence in Scottish Medicine - A Progress Report

Annex D

Leadership Development for Independent Contractors in NHSScotland

Background

Primary care faces the complex challenges associated with an exponentially ageing population and rapid healthcare technology advances set against a backdrop of global financial constraint and health inequalities. Meeting these complex challenges effectively is dependent on transformation. Now more than ever, an increase in effective leadership from primary care, from all disciplines, is essential to support the design and delivery of safe, effective and person centred health and social care for the people of Scotland.

Health and social care integration and more collaboration within healthcare will require people to let go of longstanding, very trusted and familiar ways of designing services and delivering care. New collaborative and innovative ways of doing things can seem very alien at times. Transformation and changing the culture across professions and importantly, taking the profession with us in a way which resonates with their values, goes well beyond 'just being a professional'. Effective leadership is needed. In this context leadership is framed as a social process through which change can be effected. This social process is; informed by knowledge, open to innovation, driven by professional values and critically can be developed within teams and individuals through learning.

Using an evidence-based approach, the RCGP Scotland and NES leadership project has identified 3 strands of activity needed for the development of primary care leadership capacity and capability: (1) creating the right conditions for leadership development; (2) development of direct and formal approaches for leadership development; and (3) exploiting informal and indirect approaches to embed primary care issues within existing leadership development programmes.

1. Creating the conditions for primary care leadership development

Developing leadership capability alone will be inadequate to achieve the aim of the project. The following are needed to ensure that primary care leadership delivers the 20:20 Vision:

1.1 Leadership from primary care requires different drivers and incentives within our current systems. These drivers and incentives are required both within primary care and importantly within secondary care and social care. Truly integrated patient pathways and service development should be rewarded. That is to say, health boards and social care should be asking themselves what is the incentive for their practitioners to fully embrace and incorporate advice and leadership from primary care regarding design and delivery of their services. This will be new for many;

1.2 The issue of capacity in primary care leadership needs to be addressed. Throughout the scoping exercise the need for protected time both to undertake leadership development and leadership activity has been cited by all 4 primary care contractors;

1.3 Engagement with all levels of the primary care workforce will be critical to success. Leadership should be reframed or conceptualised as a means of delivering better clinical outcomes, for example, quality improvement in patient care through leadership should be visible to the primary care workforce. Leadership which is seen as a dissonant top down imposition is unhelpful. Improvement initiatives and innovation should be supported and encouraged from all levels of the workforce;

1.4 Primary care independent contractors and their leadership development needs should be integrated with, have clear links with, and be explicitly included in the frameworks of health board Organisational Development departments.

1.5 The RCGP Scotland and NES developing leadership project also supports the national Primary Care Leads Group assertion that consistent national recommendations should be developed with regard to specific positional leadership roles in primary care. This should include recommended roles, remits and pay scales although the specifics of this are outwith the remit of this project.

If the full benefit of leadership from primary care to the 20:20 Vision is to be realised, it is essential to establish these conditions to maximise the benefits of the formal and informal development interventions below.

2. Direct and formal approaches for primary care leadership development

To develop the leadership capability from the primary care independently contracted professional groups we have considered the various options and from now, would like to focus upon;

Locality/Cluster Cross Sector Team development

We suggest and are working in partnership with the NLU to develop Action Learning Sets involving cross sector teams working on real problems facing them and the communities in which they work. Cross sector teams should include: GPs; community pharmacy; social work; health boards; district nursing; and any other appropriate stakeholders from the communities concerned. Independently contracted GPs or staff not in positional leadership roles will require backfill to attend, however the collaborative and innovative approach and focus on real challenges will ensure return on investment. Such Action Learning Sets can focus upon any topic relevant to local priorities: reducing health inequalities in communities, caring for people with multiple morbidities and chronic illnesses at home or in a homely setting, disease prevention, more effective integration, unscheduled care provision etc.

Individual Personal Development

We suggest and would like to develop a leadership programme aimed at those GPs and GP staff who have the ability, energy and motivation to provide clinical leadership for locality/clusters but who have not previously been enabled to do so. Once tested this development opportunity should be extended to the other primary care disciplines. This should be done in conjunction with the experience, advice and contacts of the NLU of NES but be administered by RCGP Scotland. Our scoping suggests that there is currently a gap in the provision of leadership development for such individuals, particularly those with an established career, but who are not employed in a positional leadership role within their local board area. This gap shrinks the pool from which future strategic and positional leaders are drawn. More leadership development for individuals will increase the number of positive role models and mentors in primary care.

A blended learning approach should be used and this could involve the use of eLearning, coaching, 360s and some face to face workshops. Independently contracted practitioners will require back fill for the latter for these. It is neither practical nor sensible to write a leadership programme from scratch and as such we will make use of materials already available or that can be easily modified. Ideally a cohort of individuals drawn from each of the area health boards would be the most appropriate place to start.

Continuing Professional Development (CPD)

We will continue to liaise and have open dialogue with NES providers to establish Continuing Professional Development (CPD) which can be delivered to larger volumes of multi-disciplinary primary care practitioners. This includes approaches such as short video updates, e-modules and the standard Leadership and Management Programme (LaMP). These are placed at the start of the leadership development journey. We have also commissioned a Practice Based Small Group Learning (PBSGL) Module 'An Introduction to Leadership'. 1,600 GPs in Scotland study PBSGL modules in communities of practice across Scotland. All GP trainees have access to PBSGL during their training. There are multi-disciplinary groups, GP Nurse groups and pharmacist groups.

3. Indirect and informal approaches for primary care leadership development

We will establish a primary care leadership narrative capable of being embedded in existing leadership development programmes. We will liaise with and have open dialogue with the NLU about primary care engagement with the currently available national leadership programmes.

Other Considerations

Appraisal and Revalidation

We will open a dialogue with NES colleagues involved in delivery of GP appraisal.

This is the main route to revalidation for GPs and could act as a lever to promote positive leadership behaviours. Such learning and development could be by formal routes such as programmes and CPD and informal routes such as mentoring and role modelling.