Skip to content

Think Bigger, Act Bolder.

The General Practice Liverpool Story

“Hearing from General Practice, once and with volume, makes every job in the system easier”  

Jan Ledward, Liverpool Director of Place, Cheshire and Merseyside Integrated Care Board.

The background

In the Summer of 2021, we were approached by the Liverpool Network Alliance to help them develop their organisational offer, structure and positioning for General Practice in the city. The project, which would later on become known as ‘General Practice Liverpool’, was set up in 2019 as the ‘network of networks’ for Primary Care Networks in the city and designed to support General Practice to come together, work together and make a larger local impact together.

 

As the project launched Liverpool Heart and Chest NHS Foundation Trust were acting as ‘host’ and organisational development partner. Through this support, General Practice Liverpool started work around extended access, leadership development and the additional roles reimbursement scheme (ARRS). The project went on to play a key role in the vaccination campaigns of 2020 and 2021 which although very successful, had taken the focus away from the organisational development side of their offer.

 

From the outset the organisation had two very clear aims, an internal aim to support development learning and support between PCNs in a time of significant change for the NHS and the wider system – most specifically through the introduction of Integrated Care Systems. In addition, the team had an external focus to ensure this new and wider ‘system’ heard the voices of General Practice in Liverpool and had the knowledge, tools and understanding to engage them in their decision-making.

The problem at hand

The city of Liverpool, like many places around the country, are in the middle of a huge period of change. The quickly evolving modern face of the health and social care system is being driven by newly formed Integrated Care Systems, and Primary Care Networks (in particular General Practice) as relatively new entities themselves needed to find and establish their place in that new structure.

 

Following the recognition of the need for a shared platform for General Practice in 2018, a 2019 review of the newly developed General Practice Liverpool highlighted an organisational development need within the existing project, with governance, independence and strategy needing more focus.

There was a need to:

  • Define and promote the offer/role of primary care in future integrated care partnerships
  • Find what brings General Practice and their PCNs together, by focusing on what values and direction we share we minimise the risk of lots of unclear voices vs one loud one.
  • Create an organisation in its own entity, at the start of the project General Practice Liverpool was part of the soon-to-be disbanded CCG. This created concerns around potential commissioner/provider conflicts of interest – what was clear was that the autonomy of PCNs needed to be retained.
  • Engage grassroots members across PCNs in doing this together – establishing the purpose and direction of travel together.
  • The 2019 review highlighted this organisational development need (high-level version of the below).

What we did

Our first piece of work was around ‘sensemaking’ working with members of the General Practice Liverpool leadership team to fine-tune the brief. We wanted to understand where they wanted to get to, what success looked like and what we needed to do to get there.


We went on to listen to a wide group of stakeholders to gain clarity on how the vision differed between audiences. We did this through an extended listening exercise with PCNs, Clinical Directors and wider system partners using one to one interviewing and workshops to get under the skin of the shared vision and objectives.

 

The questions we wanted to answer:

  1. Why does General Practice Liverpool’s existence matter, why is it important to CDs/PCNS?
  2. What would be lost if it they no longer existed?
  3. What do we want to achieve, what’s the vision for the future?
  4. What are our strengths and weaknesses as General Practice Liverpool?
  5. What are the opportunities and threats out there for General Practice Liverpool? Leading into initial thoughts for workstreams and the organisational ‘product offer’.

Over the course of several months we gained key feedback, giving us a much clearer steer on what was wanted: “It needs to….”

  • …act as a gatekeeper for our PCNS, acting as a ‘wider system’ buffer”
  • …help us engage and motivate people working in our PCNs”
  • …play a role in designing the ‘fit’ of PCNs within the wider system”
  • …. drive creativity in Primary Care”
  • …increase the resilience of our members”
  • …find opportunities for PCNs to work together”
  • …raise the profile of General Practice in the city”
  • …help us to think bigger than individual PCNs”
  • …increase efficiencies in how we as PCNs deliver”
  • …reduce complication for our members”
  • …maximise learning within primary care”
  • …continuously improve General Practice”

We then went on to imagine what this would look like creating an organisational vision, mission purpose and set of values. In addition, we developed an options appraisal for the organisational structure, taking time to work through the options, pros, and cons across a range of General Practice and system viewpoints. By co-producing this with a group of Clinical Directors through a project steering group we ensured we had buy-in and ownership from the core team at the start.

The Why

(Core Purpose): We’re here to put General Practice in the strongest possible position to bring about real change for the people of Liverpool.  

The What

(Mission): We bring General Practice in Liverpool together allowing it’s teams to think bigger and act bolder than they could do alone.  

The Where

(Vision): We want to give General Practice more time to focus on what it’s best at; making sure every patient has access to the support and care they need.  

The Values

(How):

  • Forward Thinking  
  • Driven 
  • Joined Up 
  • Adaptable 
  • Straightforward 

What we found out

Through these workshops and imagination sessions we further refined what General Practice Liverpool needed to be and what it didn’t need to be. This was key in the design of organisational structure, messaging and planning for the future.

  • Led by the voices of GP and talk to the system on their behalf
  • The benefits of peer support were really appreciated
  • Understand the benefits of its own structure but not sure about incorporating at this stage
  • Good governance to ensure fairness and solid decision making
  • Issues around leadership and resource to do this work – the need to be honest and realistic about what’s achievable
  • Solid communication, brand is key – need a shared understanding of who we are and what we do
  • Although important the purpose can’t just be driven by the funder/system- we need to focus on what we need
  • The barriers are real – a keenness not to get ‘sucked into’ performance management for fear of crippling engagement – a need to make sure there is fairness, balance and that everyone has a voice
  • Highlight the motivators for engagement – seeing the opportunities to lever budgets into community-led GP services. Seeing General Practice Liverpool as a front door for such opportunities
  • Even in its early form acts as a ‘buffer from the system’
  • It can help make savings and do things once

What we did then

1. Strategic Plan and associated processes:
From here we went on to write a five year business plan made up of core structural objectives for the organisation, and core operational objectives.

2. Fit for purpose leadership team:
We went on to recruit a new Managing Director, Chair and Medical Director, with clear job descriptions and responsibilities in line with the aspirations of the business plan.


3. Solid and aspirational governance:
As the team decided not to incorporate at this time, we supported them to put key governance tools in place including a Constitution (including Memorandum and Articles of Association), a Conflicts policy and most importantly an organisational committee made up of independent members. We supported the team to go out and find new members for the organisational committee, ensuring we welcomed members from a range of backgrounds who would both support and challenge our Leadership Team.

New brand and core messaging:

We wrote and external communications strategy and delivered development sessions with the Leadership team around relationship management and prioritising the actions within it.  

Clear approach to member engagement:

Pulled from insights developed throughout the project, we created a members engagement plan to both maintain and enhance engagement levels during the project.

What happened as a result

Over the course of 18 months we incubated General Practice Liverpool into a fully operational project in its own right, made up of its own Leadership Team and experienced committee members. The organisation is now acting as a mechanism for General Practice to engage at a regional level – giving them strategic influence and supporting sustainability of GP in the long run.

 

GPL’s objectives have created a clear focus on business development including an enhanced access project which aims to support General Practice to retain control over extensions of their contracts and create economies of scale/consistency of quality for PCNs.

The new Governance setup allows full accountability to member PCNs and reassurance of direction, risk management and controls for the wider system.

What we learnt

As in every Capacity project we completed our final reflections and evaluation report as we existed the project. Our key learning points are as follows and will be shared with partners/taken into future work to ensure we remain committed to our approach to ‘always develop and adapt’.

 

What we picked up on: Projects that involve diverse and cross-cutting leadership need to have decision making processes outlined at the outset. This gives more clarity for all project stakeholders and helps set expectations of the likely need for more time in busy and complex systems.

What we’ll do differently next time: Get the decision-making process clear at the kick-off meeting, clarifying levels of reporting and where the ‘buck stops’.

 

What we picked up on: Business management skills aren’t as developed in some areas of the public sector as the teams would like them to be and we need to ensure we do everything we can to upskill those we work with whilst recognising their supporting skillsets (e.g. clinical support or system knowledge).

 

What we’ll do differently next time: Continue to see the added value we can offer of business mentoring to our clients, whilst picking their brains to understand what else we can do to make change.


What we picked up on: Developing a detailed and clear understanding of the motivators and barriers across different audiences needs to happen as soon as possible to ensure we do our best to meet their needs and wants. Talking to people and getting people on side is what made this project a success, not the transactional parts of the process.  


What we’ll do differently next time: Create more time for shared understanding and insights across our project team of barriers to engagement and develop shared approaches to overcome these together.


What we picked up on: We can’t underestimate the value of good engagement, the vision for the future and what is possible can excite even the most burnt out and under pressure works. By selling in the potential of this project as well as what the work might bring in the future, we were able to create a sense of positivity that could have been a challenge in a difficult and changing NHS climate.


What we’ll do differently next time: As those who are positive and engaged to show the importance of taking a step-back and seeing what is possible to act as advocates for the project within and beyond its boundaries

Where we’re going next

Over coming months we’ll continue work alongside General Practice Liverpool and PCNs to increase their profile and consider how their offer fits with other primary care and wider system projects we’re engaged with. We’ll promote their role when appropriate as a suitable delivery agent in our other PCN work. Our ability to think wider than individual workstreams or organisations allows us to see the bigger picture more easily, and we’ll continue to work with our General Practice partners to view things through this different lens.  

 

We plan to come back to General Practice Liverpool summer 2023 to see what impact the organisation has made, and to update you on what’s gone well, what could have gone better and where they’re going next.   

“This was never going to be a simple project as it’s complex and new, but very exciting. I feel we’ve really got somewhere now; a platform to bring Liverpool General Practice together to ensure we’re on the map as the system continues to develop”  

Dr. Rob McGuire, Chair, General Practice Liverpool