Why the NHS is bad at sharing what's good

It was break time in a workshop for GP practice managers in the South West, and one of the attendees made a beeline for me. “I need to tell you I’m REALLY ANGRY!” she said, as she got closer and closer. I’m not a body language expert, but I didn’t actually need her to tell me – I could see.

She continued, “I’ve spent the past year or more trying to free up GP time for more complex needs. It’s been exhausting and really unsuccessful. And I’ve just spoken with a manager from 4 miles down the road who’s been working on the same thing, but has had good results. And, listening to her, there are ideas there that I could have tried and I think they would have worked – and I’m REALLY ANGRY that the NHS doesn’t share what’s working so the rest of us don’t have to struggle so much!”

That hit me right between the eyes. There are good ideas – solutions to everyday challenges – all around the NHS. And she was right – others rarely hear about them, or we hear about them in a way that seems irrelevant or unappealing.

That conversation sealed a determination in me to do more to gather and share practical solutions to the big challenges facing primary care in the UK. It fuelled my creation of a movement called Time for Care at the heart of a new £2.4bn national policy, the General Practice Forward View. And the momentum’s still going strong.

But we’re still really bad at sharing what’s good in the NHS.

Last week I spent the day with the primary care clinical directors of Worcestershire. Part of the agenda was a “quick update” from each PCN about how they’re approaching some of the big priorities for this year. The energy level went through the rood. The most common word I heard around the room was “REALLY?!”, followed by a version of “tell me more – how have you done that?”.

This is a county where clinical directors have really well-established routines of meeting together. They’re ahead of much of the country in their togetherness. Yet, an hour into the sharing time, I asked if anyone thought they should do more of this kind of sharing – the answers surprised even an optimist like me…

Survey of PCN leads in Worcestershire

So why are we so bad at sharing what's good?

I think there are lots of reasons, and it’s worth clarifying what they are in your neck of the woods before you get into improving the situation. But here are the biggest things I’ve seen:

we go straight into solving our problems before looking around to see if someone else has already done it. ‘I’m too busy chopping to sharpen my blunt axe.’ Never mind that adapating someone else’s solution is way quicker than inventing your own.
we think our situation is so unique that others’ solutions couldn’t work here. Sorry, but you’re almost certainly wrong. I’ve lost count of the number of times I’ve heard someone say that their context requires entirely unique solutions, only for one of their close neighbours to share exactly the same solution.
it’s hard to accept good ideas from people we feel threatened by. Yes, I’m talking to you! And me. In England, this tends to manifest as a rural-urban divide or an anywhere-but-London snobbery. Social prescribing started taking off in England when we began sharing examples of GP practices outside London who’d used it.
good work is often presented in an academic way which makes it hard to understand HOW other people have achieved what they have. The focus groups I ran on primary care innovation adoption for NHS England showed time and again that, when you really delved into detail, most people HAD heard about key ideas that could have helped them, but it wasn’t “actionable learning” so they let it pass.
innovations developed at the frontline are sometimes taken up and promoted by national bodies – and we get sniffy about that. I still hear people talking about things like group consultations or online consulting as though they were invented by The Government, rather than their colleagues down the road.

None of these is a good enough excuse

There are always reasons why we're bad at sharing what's good in the #NHS. But none of them is enough to excuse it. Your 'normal' could be someone else's startling innovation. #SharingIs#Caring

@robertvarnam Tweet

Please can I encourage you to JUST DO IT? Find people who do something similar to you, and make time on a regular basis to share what you're working on and how it's going. In my experience, you will always come away with ideas that will improve your work and save you time.

… and let me know how it goes, or if I can help.

Why the NHS is bad at sharing what's good

But we’re still really bad at sharing what’s good in the NHS.

So why are we so bad at sharing what's good?

None of these is a good enough excuse

Please can I encourage you to JUST DO IT? Find people who do something similar to you, and make time on a regular basis to share what you're working on and how it's going. In my experience, you will always come away with ideas that will improve your work and save you time.

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