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The Business of Healthcare: An interview with Professor Mike Holmes

Professor Mike Holmes qualified as a GP in 1995 and, in 2002, he went on to become a partner at Haxby Group, which operates practices in York and Hull. He is also Vice Chair of the Royal College of GPs (RCGP).

I spoke to Mike about how his organisations operate on business level, his approach to leadership, and his hopes for the future of general practice.

Mike: Definitely. We started off as a partnership, and about 11 or 12 years ago we redefined ourselves as a Medical Business with General Practice at its core.

As a practice, it’s easy to think of patients, the public, as your customers, but our contracts are with the government via various CCGs, so I have a mixed view. I know why I’m here and who I’m serving and that I’m practising patient-centred healthcare. In the training business we deliver education to staff and employees of other agencies. In the community pharmacy we run, our customers are both our patients and the NHS with whom we contract.

Mike: We’ve always been a large practice and open to innovation. In 2002 we appointed a new manager who became a partner in 2005. He had vision and the ability to implement change.

We have diversified by delivering services in two cities, develop community pharmacy service as well as a training company. We are in the process of transforming our workforce and challenging ourselves to do things differently.

Clinical leadership was given more focus – it wasn’t a thing squeezed into the middle of the day. The combination of clinical and non-clinical leadership has been critical. I just do one day a week clinical and the rest of the time I work in the inter-organisation space. In both cities, we have a Head of Nursing in Advanced Practice who are not clinical. It can feel counter-intuitive taking clinicians away from patients, but it’s made a massive difference.

Mike: I see my patients. I have a specialist interest in vasectomy, so I spend half a day doing vasectomy operations. Two days a week I’m in London for my role as Vice Chair of the RCGP. I also Chair the Federation in York and chair the Facility of Advanced Clinical Practice. So, we’re plugged into the healthcare economy, locally, regionally and nationally.

Mike: I’ve done a Master’s in healthcare leadership through the Leadership Academy and I’m on the Clinical Executive fast-track programme. I’ve also had some coaching and I get a lot of support and mentorship from my managing partner. I have felt privileged to receive all this support.

The Leadership Academy helps us reflect on what we do, our decisions and projects. Now we’re moving into ‘action learning’ – there are seven of us, all clinicians and all in senior leadership positions. We’re going to be working together presenting problems and asking for input.

Skills-wise, resilience is important, and I think understanding purpose, communication and relationship building. And then ‘sense making’ – so understanding what is needed at practice level, influencing the system; and then seeing what’s going on at system level and helping the practice be proactive in response.

Mike: We have a team that writes bids and we know how to negotiate and have those conversations. Being open, transparent, building relationships and delivering quality help make those conversations less difficult to have.

Mike: It’s always a challenge when you do things differently. But I can’t stress how important it is to have strong relationships and high levels of trust within your organisation. Once you’ve got those in place, task delegation becomes easier and change can happen. A clear agreed strategy is so important.

Mike: Loads! I really enjoy reading them – stuff about change, doing things differently, relationship buildings, emotional intelligence and autobiographies about other leaders have all been very helpful. One of the most helpful things I’ve read recently is by Otto Scharmer ‘The Essentials of U Theory’ - its talks about really paying attention to the people and the world around you as a step to achieving the best possible outcome. The reality is, whatever you do isn’t going to fix the system because there is no perfect solution…it’s a wicked problem. I love challenging the way we’ve always done things.

Mike: In general practice it’s not unusual to have a business ethos because of our independent contractor status. We’re responsible for employees and running an organisation and from my perspective it brings huge positives.

In other sectors, despite a lot of emphasis on trying operate like a business, it is fundamentally different as the ownership does not lie with key individuals. Some might argue that’s a good thing, others might argue that affects productivity and commitment. Its complex but I fully believe we, and indirectly, our patients have benefited from the ownership and commitment of the partners at Haxby Group.

Mike: Not much! The organisations I work in have a sense of shared ownership, shared responsibility and trust. I see GPs who are in a very different state: their morale is low and they’re under huge pressure. Being willing to try different things has protected us and managed our workload. Of course things are never going to be perfect but we feel like we are moving in a good direction.

I think we have benefited from a proactive approach – involvement with patients, with our staff and with the wider health and social care community, locally regionally and nationally.

Mike: I’ve heard phrases like ‘game-changer’ being used. It could be, but I think there’s still a lot of detail to come. There’s resource attached to it and it talks about workforce transformation, so it’s got potential. At Haxby, we’ve got this network structure already in place, so we’re well positioned to take it on the next step. I believe that a collaborative approach to service provision is right.

My hope is that we can really embrace a ‘bottom up’ culture and although those who really know the populations they serve to co-design service with population.

Mike: I’d like to see the NHS developing its own talent, but the question is how we use workforce and digital transformation to manage to release leadership capability.

External consultants can come in and innovate. Sometimes they tell you what you already knew but haven’t got the time and ability to do. I would love to see that talent emerge from within.

Mike: In 2014 only two to three per cent of our practice nurses were under the age of 40. Now we’ve got more in their 20’s than any other age group. It feels really exciting and dynamic.

At the RCGP we are really trying to work with our younger members from university right through to mid-career. We have a long way to go to get things right but we are listening and as important we want to do things differently. I am excited to see what the next few years bring.

Mike: I’m pretty convinced that the way we’ve provided General Practice for the last 70 years cannot be the way we do it for the next 70 years. I believe we must be pragmatically optimistic and be prepared to think differently.

In the NHS people are asked to work harder and harder and harder with the same resources. Ultimately the quality of the service will be affected. We need to start thinking about workforce transformation to allow fewer, much longer consultations to give them head space to make proper decisions. Technology will also be important moving forward – we must ensure we get the basics right whilst trying to innovate. Whatever we do must have patients at the heart of it.

It was fascinating learn more about Mike’s passion for finding structural, technical and workforce solutions that unlock excellent clinical care and allow leadership talent to thrive to thrive.

I think we can learn a lot from the way Mike talks about actively tackling business problems and striving for improvements in practice, while not letting perfectionism stand in the way of progress.

Tara Humphrey is the founder of THC Primary Care, a leading healthcare consultancy specialising in workforce transformation and the only consultancy to have worked with 11 Training Hubs across South London, Kent, Surrey and Sussex.

Tara and her team also work with GP federations supporting the implementation of clinical services.

Tara has over 20 years of project management and business development experience across the private and public sector and has an MBA in Leadership and Management in Healthcare, is published in the London Journal of Primary Care and is the author of over 100 blogs.

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