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These blogs are about the NHS - but also about numbers. I hope that they raise some interesting points that come from the data. Sometimes I suggest that the data doesn’t look right - but maybe it is. Please tell me when I have got it wrong (as we all do, however carefully we look at it) or when I have got hold of the wrong end of the stick. And especially tell me if you can see a rationale or logic for the picture that I describe that I have missed.

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Doing less and achieving more

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I want to share a few thoughts as I hand over the baton to a new generation of leaders in NHS Alliance and return back to the Primary Care Foundation. The best example of offering advice to a new generation is the one and only no.1 hit with a clear and unambiguous public health message – Baz Luhrmann’s 1999 ‘Sunscreen Song’ – which highlights that the only advice he can offer, which is genuinely based on evidence is ‘use sunscreen’.

For my part, I would like to take a fresh look at how we make decisions in the NHS and the importance of something economists and psychologists refer to as action bias. Put simply, action bias is the idea that when faced with difficult situations we tend to get the feeling that we need to take some action regardless of whether this is a good idea or not. It follows that we would make better decisions if we had an awareness of the unconscious psychological processes that drives our decision making at times of stress.

I recently noticed a link to a great 7-minute video that focusses on what happens in a goalkeeper’s head when they try to save a penalty. Now this is all pretty close to home for me – as some of you may know my son started a career as a professional goalkeeper and has since managed to turn his passion for football into a career as a goalkeeper coach.

As my son always tells me, goalkeepers love penalties. They can’t lose. The striker is expected to score but if he saves a penalty he is a hero. Interestingly, when he was still playing in goal he took this a stage further and decided that he should do everything he could to distract the striker as he prepared to take the penalty. He would walk out of the goal and move the ball, argue with the referee and tell the striker where he was about to hit the ball. It was a nice theory, but it was at best unproven – the only certain thing was that he got booked a lot and created a name for himself with referees.

So what did the video have to say? Academics, with nothing better to do, spent a lot of time reviewing thousands of penalties and they found out something very interesting. They discovered that goalkeepers would save more penalties if they did nothing, or just stood still.  But, this isn’t what goalkeepers are trained to do and a heroic, if pointless gesture, feels much more satisfying than remaining rooted to the spot. This is where action bias comes in, we feel better doing something and there is plenty of evidence that doing less has better outcomes in other fields too. Traders on the floor of the stock market are primed to do things and make rapid decisions, but the research shows that those who trade less are actually more successful.

In healthcare, there are many examples of action bias. GPs opt to prescribe antibiotics even when they know it will have no impact and contributes to broader harm. And, politicians and policy makers exhort general practices to offer more appointments, doing more and working harder, when we know there is greater patient satisfaction in practices who offer fewer appointment slots. Or put another way, general practices that struggle most are those that respond to the increasing pressure they are under by doing more – offering more appointments rather than standing still for a bit and thinking.

So, I offer three reflections to the new leadership team.

First, the answers to problems are often counter intuitive. So, put simply, doing something – anything – especially when you have no evidence that it is the right thing to do, may not be smart. You may just be digging a deeper hole.

Second, productivity is not just about doing more – headline figures for productivity invariably rise at a time of austerity or financial crisis – but being genuinely productive, so improving how effective we are rather than just being more efficient, takes careful thought and reflection.

And finally, I would encourage everyone to spend more time following up random links and videos as they may just trigger a new way of looking at the same intractable problems. If we are serious about transforming general practice and primary care, rather than just doing more of the same, we need to give people the ‘headspace’ to come up with creative solutions.

Rick Stern

Outgoing Chief Executive, NHS Alliance

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Guest Friday, 22 June 2018

About Us

The Primary Care Foundation was established to support the development of best practice in primary and urgent care.  The three Directors bring different skills and perspectives to understanding primary and urgent health care - for more details click below:

David Carson

Rick Stern

Henry Clay

 

 

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New on-line registration for the potentially avoidable appointments audit

The Primary Care Foundation were selected by NHS England to further improve and automate the audit of potentially avoidable appointments. We are now building a new website with Method Analytics that will make it much easier for any practice to register online, will simplify data collection for clinicians, and will allow for instant reporting on results. The reports will be much easier to understand and will signpost other support. And it will remain free to use for all practices in England.

We are now ready to go live with a new ‘test’ site. We are confident it is already easier to use but we are keen to get any feedback from practices before the new website is fully up and running.

If you are a practice in England and you want to register, CLICK HERE  and click on ‘register here to create a practice audit!’ You will be guided through registration and how to set up your clinicians to take part in the audit.  This is a new test site, so if you notice anything that doesn’t look right, or could be made easier, just let us know.  And the same for your clinicians as they enter data – any feedback at the moment – good or bad – would be really helpful … just email us This email address is being protected from spambots. You need JavaScript enabled to view it.

 

What do we mean by an ‘avoidable appointment?

The latest blog by Rick Stern ‘If only …’ explores the idea of avoidable appointments, what practices have gained from the audit, and what might be possible with further investment in general practice. It is available HERE and will also be published in Health Care Leader.

 

Are there any simple lessons for practices looking to improve access?

A feature article in Management in Practice by Rick Stern reviews what we have learned from working with over 1,500 practices across the UK – you can read the full article HERE  

 

Integrated Urgent Care – how to make NHS 111 work

A lead article for Health Care Leader by Henry Clay describes a financial and capacity model developed for NHS England, the potential benefits and pitfalls, and what we have learned from working with a dozen areas to apply the model. The article is available at HERE and a fuller version with a number of explanatory graphs can be downloaded HERE

 

Integrated Urgent Care – opportunity for support to your locality

We have developed a financial model for the Integrated Urgent Care Team at NHS England that focuses on the NHS 111 and OOH ‘front end’ to an integrated urgent care system (but also looks at the cost of onward referrals to other services). This is proving to be an invaluable tool for both commissioners and providers. It is now available to use and NHS England have also agreed to support some sites to setup and work through the model with PCF’s Henry Clay who developed the model. For further information please contact Henry on This email address is being protected from spambots. You need JavaScript enabled to view it.

 

We are now supporting over 1,500 practices across the UK to manage access and urgent care

Our support for general practices looking to improve access for patients and streamline the management of urgent care continues to expand. Based on a web based tool, developed out of our work commissioned by the Department of Health, we collect practice data for one week and prepare a report for each practice looking at how you compare to others and explore what this means for making practical changes in the way you work. We are regularly improving the format of our reports for practices based on constant feedback. If you would like to see an example report, CLICK HERE.  If you want to know more about how we might work with you please contact Rick Stern on  This email address is being protected from spambots. You need JavaScript enabled to view it.  or call on 07709 746771.