Improving Patient Experience within Primary Care in East & North Hertfordshire Clare Hawkins Deborah Kearns Heather Moulder Nicky Williams

An Overview of the Current State 500,000 population in East and North Herts with healthcare commissioned by CCG, NHS England and Herts County Council Providers include primary care (General Practice, et al) 2 acute trusts, community trust and mental health trust Programme of integrated service delivery underway and includes all partners General Practice profile – long established, estate stock adequate, above average QOF outcomes, few single handed GPs, some appetite for federations Patient experience poor – 50% below national average in 2013/14 Issue traditionally looked at as a GP issue, not seen in context of health and social care system

Weighted pop 109k Weighted pop 69k Weighted pop exc. Knebworth 92K Weighted pop. 52k Weighted pop. 111k Weighted pop. 109k

The Problem The problem is… Using National metrics there is below average patient experience with Primary Care in East and North Hertfordshire

The Objective The objective is… To improve patient experience with Primary Care (General Practice) in East & North Hertfordshire to at least the national Average, as measured by the National Survey, by September 2017

Root Cause Analysis 5 strategic areas identified; User culture – rising patient demand, empowerment, expectation, increasing co morbidity, desire for continuity of care Staff culture – attitude, morale, levels of team working and staff confidence Workforce – coordination of multiple providers, skill mix, recruitment and retention, capacity, education and training requirements System design - access and smooth transition of care, perverse incentives and procurement rules acting as barrier to effective commissioning Infrastructure - IT, telephony and limited premises investment

Strategy Selection Strategic option is: Exploring and improving staff culture within and between provider organisations Options evaluated for likely impact on problem using parameters of expenditure, political feasibility and time required Human factors can prevent effective large scale change Tackling culture change supports local integration work and delivers long term sustainable change

Implementation Plan This project being agreed as part of the overall workplan of the integration transformational change programme Actions include; engagement plan, tool development, baseline measurement and analysis, system feedback, defining OD interventions and delivery, retest baseline and analysis of national survey 2017 Chose a project that is accepted at strategic level - recognised need to start culture change at frontline, operational and strategic levels for success Resistance - unconscious resistance, attitudes in clinical practice and our own resistance

Evaluation KPIs are mix of process and outcome measures –Cultural measurement tool and baseline –Design of OD interventions –Baseline retest –Metrics from national GP survey 2017 Overall indicator of success is –positive improvement in staff’s cultural attitudes in relation to integrated working –improved primary care experience as measured by the national GP survey

Lessons Learnt Longstanding problem previously tackled on piecemeal basis with limited success. Solution to work on system wide basis is ambitious and will take longer than anticipated Group work was challenge but greatest asset – organised and committed with time together, trust others to take responsibility for delivery of work, effective communication Leadership roles in our jobs allowed us to use existing structures/processes and access resources Invaluable to spend time on problem solving, agreeing and prioritising

Lessons Learnt Extensive range of experience and backgrounds led to greater understanding of wider context Peer challenge of ideas and preconceptions resulted in agreement of joint values and actions Impact on own beliefs and relationships with our organisations/self reflection on culture and functioning Working and agreeing on shared values across organisations - leading by example and role modelling positive behavioural change