This week’s leadership message comes from Jim Barwick, CEO, Leeds GP Confederation, and our blog is from Amritpal Reyat

Do you ever get that sinking feeling when you’re on holiday and someone asks, “so what do you do?”

I’m the CEO of the Leeds GP Confederation and I imagine you may well be asking the same question. I’d like to explain what I do and how my NHS career, from student nurse in 1985 to the present day, has shaped how I work and what I do.

GP federations have been around in various forms for many years; however, they are not all the same. The Leeds GP Confederation (Confed) was born out of three federations in Leeds. One still exists, the other two are now defunct. This is the only reason we call ourselves a Confederation, to make the distinction from old to new.

We believe, and global evidence shows, that with strong general practice as part of wider primary care, the health and wellbeing of populations is improved. So, the Confed’s purpose is focused on this, with two main aspects: 1. To be a voice for and represent general practice; and 2. To hold contracts to enhance access to healthcare across Leeds and provide a range of services to general practice.

So how do we actually do this and what have I learned which has helped shape our work? I’ve split this into three component parts that mesh together, the sum being greater than the parts.

Voice and representation

My last clinical role was as a transplant co-ordinator. For five years this meant going to a hospital you weren’t familiar with to enter a sensitive situation, organ donation, and to work with staff who will have had a difficult day where you’re asking them to do more, often working into the early hours for a benefit they will never see. 

This experience honed my leadership style and now, when I am in a room full of GPs, with challenges and diverse opinions, I can draw on my experience, to be authentic and understand others to create a trusting relationship. From there, the practical work can develop.

We have created a mechanism for voice and representation, where themes and issues are understood, having feedback loops. For example, we have general practice representatives in all of our population boards and key governance meetings throughout the Leeds Health and Care Partnership. Distributive leadership is important, with a flat hierarchy where all opinions count. We do this with the local medical committee (LMC) and the integrated care board (ICB) and have formed a productive working relationship. A trusted relationship part is a key theme throughout.

Contracts and services

Over the years we have established a reasonably significant portfolio of contracts, all focused on our purpose. We are finding increasingly that our contracts are in collaboration with other providers, and this drives integrated working. For example, our community dermatology contract has brought together a number of previous AQPs (Any Qualified Provider) with hospital consultants. After a period of time developing trust and relationships, the development of pathways and processes to support improved access has been impressive.

I remember working on a general medical ward when I was a student nurse. There was an old guy who was having rehab following a stroke. He was in an end bay and one afternoon it was quiet, so I went to chat with him. We didn’t have much in common (I would have been 19 at the time), so we sat in silence for a short while but were comfortable with this. The physio arrived and remarked how well he looked. He replied, and I’ve never forgotten this, “I’ve been having a conversation, we didn’t say anything, but we had a conversation”. Human contact in a therapeutic setting is important. It’s the same with leadership. Get people together, connect and create an environment where people feel safe, challenge with respect being kind and, in my experience, good things emerge.

One of my most proudest achievements of late has been our CQC rating of outstanding. It’s not so much the rating itself, it’s the culture and behaviour of all of my colleagues, truly professional, good people who work for each other to ultimately benefit the people we serve.

Our role in the health and care system

As already mentioned, the Confed has representation throughout the health and care system in Leeds. This is a two-way street. Being cemented into the health and care system has needed the health and care system to accept us. This has happened over time and due to the open mindedness of my colleagues throughout the system but also the contribution the Confed can make.

Our contribution ranges from actively participating in forums such as the Health and Wellbeing Board to rapidly standing up urgent care service to respond to winter challenges. We reflect, learn and develop all the time and I believe our contribution is valued. I personally do not take this responsibility lightly.

A few years ago, a good friend of mine was having treatment for cancer, from which he fully recovered. During this time there were conversations about winter pressures and what services should remain or pause if the pressures got too great. Cancer treatment tends to be ringfenced for good reasons, but it did focus my mind on what if a decision I made as part of a collective leadership in the city had a direct impact on my friend. This is a challenging thought, but then, shouldn’t we have this thought for all services we consider when times are tough? And this brings me to my final reflection.

What difference can we make?

Over the last five years or so, my father in-law has had progressively worsening dementia. He has just moved into a care home where he seems happy and content, although his world is clouded by his dementia. During his last few years at home the things that were important to him and made a difference were:

• His homecare carer and this being consistent. Also, his unpaid carers, family members.
• The Monday voluntary older people’s lunch club.
• Having simple, well communicated, and coordinated services to access, particularly the GP and the dentist, where people are compassionate.

Therefore, when we are making decisions, it’s important to understand and listen to what people value, much of which will be small things to us but huge to that person. When we are responsible for health and care services, we need good communication, coordination and compassion - the three Cs, which we actively embrace in Leeds.

Lastly, in addition to my day job I’ve been a trustee of a charity for eight years, and I became the chair a few years ago. Pennine Domestic Abuse Partnership provides domestic abuse support and refuges in Kirklees. I would encourage anyone in a leadership role to be a trustee. Not only will you get great reward from this, but you’ll be grounded in the reality of often the most vulnerable people in society and make decisions accordingly.

Thank you for reading,
Jim

@mrjpbarwick