Latest / Embedded / NHS Adoption: Why Interest Is Not Enough | Embedded Conversations With Sarah Bruen. Ep 11

Transcript

NHS Adoption: Why Interest Is Not Enough | Embedded Conversations With Sarah Bruen. Ep 11 · Embedded

0:02
Welcome to Embedded Conversations, the podcast that explores
0:06
what it takes to embed ideas, innovations, and partnerships inside the NHS.
0:11
I'm Scott McKenzie, and I work with NHS leaders, commissioners,
0:14
and life science companies to change patient pathways for the better.
0:18
This podcast brings those ideas to life through shared stories from people
0:22
inside the system who talk honestly about what works, what doesn't,
0:25
and what it takes to embed change in the real world.
0:28
If you're working in, around, or with the NHS and you want to understand
0:33
how change really happens, you're in the right place. Hi everyone and welcome
0:37
to the latest Embedded Conversations, where this time I'm delighted to
0:41
welcome Dr. Sarah Bruun to the podcast. Sarah brings a really valuable perspective
0:46
on how decisions are actually made in primary care, primarily because she's
0:50
viewed the NHS from several different chairs as a GP partner,
0:53
a Primary Care Network Clinical Director, Federation Medical Director,
0:57
and she was previously the CCG Clinical Chair.
1:01
So that combination really means Sarah understands something
1:05
that industry teams can easily underestimate, that a positive
1:09
NHS meeting and adoption decisions are completely different things.
1:12
An idea can have really strong clinical evidence, enthusiastic supporters,
1:17
and an obvious patient benefit, but still struggle to move forward once workload
1:21
and the workforce and the clinical risk and governance, finance, and all the accountability
1:25
come into the conversation. So today, Seda is going to help us
1:29
understand and get underneath the organisational charts.
1:33
We're going to understand what really happens after somebody says, that sounds interesting.
1:37
We'll look at who actually has authority to say yes, who else you might
1:41
need to involve, what are NHS leaders silently assessing
1:45
while an industry team is presenting, and What separates a
1:48
pilot that becomes business as usual from one that quietly
1:52
disappears? So today I'm going to explore with Sarah how primary care
1:56
adoption decisions are really made, the invisible filters that shape them,
1:59
and what pharma, medtech, and device companies need to understand
2:03
if you really want to move from good conversation to genuine pathway
2:07
challenge. Sarah, it is a real pleasure to have you on the podcast,
2:10
so welcome. Thank you very much. Thank you for inviting me.
2:14
I know, I'm really looking forward to this as a conversation because you do bring
2:17
a very, very different perspective to the party.
2:22
So if I dive straight in, you've looked at NHS decision-making
2:26
from several different chairs: the partner clinical director,
2:29
federation medical director, and of course from the CCG clinical chair.
2:34
So when somebody says the NHS liked our
2:37
idea, does that actually tell us very much And what's the
2:40
difference between somebody liking an idea and then an organisation
2:44
really being prepared to adopt it?
2:48
So I think firstly, sometimes look at the NHS and think it is one organisation,
2:52
but it isn't. You know, the NHS is made up of many organisations,
2:57
from the ICBs that do our commissioning. You've got hospital
3:00
trusts that are separate organisations, you've got community providers,
3:04
and you've got GP at scale organisations like federations,
3:08
and you've got individual GP practices, and we're all separate organisations.
3:12
Yes. So my first question is, who have they spoken to? Which part of the
3:15
NHS is that? I think that's a really good point because I
3:20
often highlight to people— you're right, by the way, Sarah, people from industry
3:24
look at the NHS and see it as the NHS. But the point I would
3:27
make is patients don't see it that way. So we've got all those different organisations,
3:32
but that's not how the patient sees it. The patient genuinely does see it as,
3:35
well, I'm going to my GP or I'm going to the hospital or going to
3:38
the community provider. That's how they'll see it, but they experience their care through pathways
3:42
in reality.
3:45
Yeah, yeah. Sorry, you asked me a second part of that question.
3:48
Yeah, sorry, the second part was when somebody says the NHS liked our
3:52
idea, it doesn't really tell us much. What's the difference between somebody
3:56
liking the idea and then you being prepared to adopt it? What makes the difference?
4:03
Is that idea something that is solving a problem
4:07
for us? Is it solving an issue in a
4:11
pathway? Is it going to make a pathway easier? And the big question
4:15
is always, where's the funding coming from? Yeah,
4:19
I'm really pleased you brought that up because it is a constant recurring
4:22
theme in my work. And we'll definitely come back to that, is where
4:27
does the money come from? Because often that is the blocker to things moving
4:30
forward. So I find industry
4:34
will often talk about finding the decision maker.
4:38
Now, does that person really exist in primary care? If somebody
4:42
wants something adopted across a practice, a network, a neighbourhood, a federation,
4:47
who actually needs to believe in it and who has the ability to stop it?
4:52
I think it depends on the organisation they're talking to. Okay.
4:55
When you look at primary care organisations, Um, a lot of practices are
4:59
partnerships, so there isn't one decision maker.
5:04
There may be a number of them which are the partners.
5:08
Um, so you need to get all of— generally all of those people
5:12
on board, but it depends on what is the decision-making process in that practice.
5:16
Okay. Because we all have partnerships agreements, which makes it something different about
5:20
decision-making. Um, PCNs, um,
5:24
again, quite— can be, can be different.
5:28
So PCNs, for my— for instance, my PCN is, is just my
5:32
practice because we're a big practice, 50,000 patients with 6 sites. So we are
5:36
a single practice PCN, but many PCNs are made
5:40
up of a number of different practices. And, and so the people in those meetings,
5:43
in the PCN meetings, often need to go back to their partners in their organisations
5:47
to make a decision. Federations and primary
5:51
care at scale again, they can be set up in different ways, so how
5:54
the decisions are made can be different. So understanding, um, how that
5:58
organisation is made up is really key. So for my primary
6:02
care at scale organisation, which is the Bruno Health Group,
6:05
we have a board of directors. Yeah, directors is made up of
6:09
clinicians from each of the primary care organisations.
6:13
So we make decisions together, but each of those directors again will need to go
6:16
back to their practices and get agreement from the practices for us to move forward
6:20
with the decision. So it can take time. Well, it will take
6:24
time. And again, one of the other things that I think industry underestimates is
6:27
that I actually think you need 3 legs on your stool to make your projects
6:31
come to life. You need the clinical buy-in, then you need the operational buy-in,
6:35
and then the one you've mentioned, the financial buy-in. Those 3 have got to
6:38
align to bring a project to life. And often I think we get stuck on
6:42
the clinical. We get the clinical buy-in. That doesn't mean operationally it's deliverable or
6:47
financially we can afford it or somebody's going to pay for it. Is that right?
6:50
Yeah, you'd agree with that? Yeah, yeah, completely. I mean,
6:54
I think that we see lots of good ideas. So let's assume
6:57
that we've got an idea, it's got good evidence, it improves the
7:02
patient outcome, everybody around the table likes it. Who might still say no?
7:06
And what are the questions going through your head that
7:10
the person presenting to you probably doesn't realise that you're thinking about
7:14
or asking?
7:18
Who might say no? Again, going back to that,
7:23
what we said earlier is there are a number of people in a partnership,
7:27
so there will be people with different views. But you've also got managers
7:31
as well as clinicians in that. Some of the managers are partners,
7:36
but some of them are employees, but they either way, they have a very important
7:39
voice. Um, and as to how you might adopt something and how
7:43
that might work. Um, so any product needs
7:46
to clinically work, but it also needs to
7:50
operationally work and, and be able to, um,
7:53
to make that happen in, in primary care. I guess
7:57
what's, what's, what's going to, to stop it is, is,
8:01
is one is the capacity. Um, uh,
8:05
there's, there's an awful lot going on in practices, and,
8:09
you know, and You're often firefighting,
8:12
trying to manage capacity on a day, people going off sick,
8:17
systems going wrong, CQC ring up and say, we're coming to visit you.
8:21
There's so many things going on. So when you get asked to be involved
8:25
in a project, you may like the idea, but sometimes
8:29
you just have to say, now isn't the right time. We haven't got the capacity
8:32
right now to be able to do that, is one
8:36
of the biggest issues. But it's also thinking, okay, where is
8:39
this going to sit? I can see this is a great idea, but we can't
8:42
afford it. Um, so where's the money going to come from? Yeah.
8:45
Um, so how can an organization that is pitching
8:48
an idea, how can they help us work through the pathway
8:52
and where the funding might come from? In fairness to you, and you
8:56
know that I say this to you all the time, I have you sat here
8:59
a lot of the time when I'm listening to people pitching me ideas, because I
9:02
know that the one question you will always ask me is, who's going to fund
9:05
it? If you're asking me to do extra work in primary care, no matter how
9:09
good the idea, before I look at the capacity and before I look at
9:12
what it does to my operational delivery, I need to know that if we're being
9:16
asked to do more, there's a funding pot to cover that cost. A lot of
9:19
people don't understand there's a difference between what sits inside core contract
9:24
and is expected of you, and if it doesn't sit in there, it needs an
9:27
additional funding source.
9:30
Yeah, and I think that's key, that I think often people
9:35
don't understand how primary care is funded. Yeah,
9:38
yeah. So, you know, the traditional way that
9:42
primary care is funded is through that core contract that you mentioned,
9:46
the GMS or PMS contract. So you get an annual payment for each patient,
9:51
no matter how many times that patient comes. And I have to go back to
9:54
the example, last year we had a patient that came 100 times. So that £130
9:59
that you get suddenly is
10:02
not very much. So when people are pitching to you about
10:06
products that are thousands of pounds, you have to go, okay,
10:10
can we afford that and still do our core day job?
10:13
I see, again, I think you're touching on something here for me that is really
10:16
key when it comes to getting projects in. You kind of indicated that,
10:20
you know, the workload and the operational capacity will absolutely
10:24
influence the adoption. And again, I find companies coming to
10:28
me, and I had a conversation a couple of weeks ago where they've got a
10:31
national decision. So they've got a decision nationally that yes, the product
10:35
is good. But for me, that says that something
10:39
could happen. It doesn't say that something should happen, because for
10:44
me, if implementation creates more work in already stretched primary care teams
10:48
and the money isn't right, what's going to win? The strategy,
10:51
as in nationally we'd like you to do this, or the Tuesday morning reality
10:55
of a busy general practice? And I think I know the answer you're going to
10:57
give me. Yeah, the reality is we
11:02
have— our job is to look after our patients, and they have
11:05
to come first. And so, you know, if I'm
11:09
meant to be, say, on Tuesday going to meetings and meeting,
11:14
trying to work on a pilot, actually, if one of my colleagues goes off sick,
11:18
then I have to drop what I'm doing and I have to go and cover
11:21
that clinic. So things like pilots and
11:25
great ideas sometimes have to be put to the side when the reality
11:28
is we have to see the patients, we have to file the blood results,
11:31
we have to do prescriptions. Yeah, I think it's a good reality check for
11:36
people. And as I say, I often highlight
11:39
to industry, national decision-making is great, it's a great
11:43
thing to have, but where you then need to focus is local adoption, because that's
11:47
where it will make or break. Your service, your product, your idea.
11:51
It will not be the national decision. It will be whether or not Dr.
11:54
Bruin and the partnership, the network, the federation can actually
11:58
adopt this operationally. Yeah. Yeah.
12:01
And so where do kind of clinical governance,
12:04
information governance, things like the DPIA sit in all of this?
12:08
And at what point do they become kind of genuine adoption considerations
12:12
rather than, you know, a kind of an administrative box to
12:16
tick? How much does that question, who carries the risk if this
12:20
goes wrong, actually influence the decision-making?
12:24
Yeah, I mean, sometimes it does feel like you're ticking a box, but actually,
12:28
when you— they— it's a very important box, is the point.
12:32
Yeah, because there is a lot of risk. That is. And, you know, when you
12:35
talk about practices, practices are generally—
12:40
they are partnerships. And they're not, so they don't have limited liability.
12:44
They have an unlimited liability. And we are the ones that carry the
12:48
risk. Yeah, you do. If something goes wrong,
12:52
then it's us that take that risk personally. So it is a massive
12:57
decision. Right. And it's really important to get the governance
13:01
right. You know, and a great example is there are a lot of AI products
13:05
coming out. Yeah, yeah, yeah. And practices are trying to decide which of those they
13:08
adopt and what's the risk in that. And AI triage is a really
13:12
good example of that. You know, how much do you let an AI product
13:16
make decisions about whether a patient is seen or not? Yeah,
13:20
because there's massive risk if that goes wrong, which is
13:23
why practices are very cautious about what they take
13:27
on. Yeah, naturally. I know in some of the companies
13:31
that I work with, and certainly in the other company that I have, which is
13:35
the diagnostic company, we have people that are dedicated to looking at the governance
13:38
and the risk and how we manage it so that we don't expose
13:42
our clinical leads or the company to problems. It's really
13:46
key in getting good implementation. You absolutely want the governance to
13:50
be right, and then you can put it to one side and you know it's
13:52
there if you need it, you know, and it just becomes a routine. For me,
13:55
it's the routine of the way that you work. It has to be safe.
13:58
Yeah, I think what's really helpful when organisations
14:02
are approaching us with products and wanting us to try pilots is actually
14:06
if they can have a sort of skeleton of a DPIA. Yeah,
14:09
yeah, yeah. You know,
14:12
clinical risk summaries and things written for us that
14:16
can then be amended if they need to locally.
14:19
But if they've already done some of that work for us, that's really helpful.
14:23
I mean, that tees up a really great route to
14:27
go because I know industry loves a pilot. I am
14:31
moving away from the word pilot, I have to say. I now use the word
14:34
demonstrator because I think that
14:37
really what you want. You want to create the business as usual model and then
14:41
demonstrate that that works rather than pilot. I often
14:44
highlight, it was Roy Lilly who said this first, the NHS has more pilots
14:48
than EasyJet. So what separates a pilot that becomes
14:52
the business as usual model from one that produces a great evaluation
14:57
but then quietly disappears? And I suppose that links into what
15:01
I was saying, should the route to sustainable services really be understood
15:05
before the pilot or demonstrator even starts?
15:09
In an ideal world, yes.
15:13
Yeah, because I think when you just try a pilot without
15:17
having thought about the funding route
15:21
and where it's going to sit in a pathway, the chance of that being adopted
15:25
is much less. If actually when you start something,
15:29
there's already been a discussion about how that might be funded and discussions are
15:33
already happening with ICBs, etc., if they need to.
15:36
Then if that pilot works, then you're
15:40
carrying on a conversation with the commissioners for something they're already
15:44
aware of, they've been involved with. Yeah. And then it's a much easier conversation.
15:48
But actually, when you come to them with the evidence of saying, look what this
15:51
has done— this is most importantly needs to improve patient care,
15:55
but if improving pathways and if possible saving money as
15:58
well. Yeah. And do all of that and present that to the ICB,
16:02
the chance of getting it adopted is much better. But if they're involved
16:06
from an early onset, then that's a much easier conversation to
16:10
continue as you're going along. I think it's a really interesting point that you've made
16:13
there. It's one of the things that I try and build into all demonstrator models
16:17
in the contracting of it, that we start to measure early. So I
16:21
usually start to measure right from month 1, month 2, month 3, month 4,
16:24
month 5. Let's assume we've got a 6-month pilot or a 9-month pilot, doesn't really
16:27
matter what. What I then do is I would have the trigger
16:31
mechanism built in. So in a 6-month demonstrator, I'd have it built in
16:34
at month 4. Are we scaling this up and making it the business as usual
16:38
model, or are we shutting it down at the end of month 6 and putting
16:40
it back the way it was? And same if it's 9 months,
16:43
I'd be looking at month 6 or 7. Are we scaling it up to business
16:47
as usual, or are we closing it down and putting it back the way it
16:49
was? So that there's a clear decision-making that actually we like this
16:53
and we want to keep it, rather than what tends to happen is we're on
16:56
a pilot for 6 months, it stops, and then we navel-gaze for months
16:59
and weeks and years on end and never actually bring the blooming thing back
17:03
to life. Yeah, that's very true.
17:07
6 months goes very quickly when you're doing a pilot. So the better prepared
17:11
at the beginning and the time spent thinking, okay, how is this going to be
17:15
funded long term? How is it going to work? Where is it going to sit?
17:17
The more of that that's done beforehand, the more successful
17:21
you're likely to be in scaling that up at the end of the 6 months.
17:24
Yeah, I think that's a really great takeaway message for
17:27
industry that, you know, come with a business, come and help us develop the business
17:31
as usual model. Get that implemented so that it will scale at the end rather
17:36
than have a pilot that comes down. And I think it's a great takeaway,
17:38
a really good takeaway. And how much of the
17:43
kind of work with industry comes down to trust? What makes you trust somebody
17:47
from industry? And what makes you, or what does somebody do in
17:50
the first kind of 5, 10 minutes of a meeting that immediately makes you kind
17:54
of think, right, I'm going to be really cautious?
17:59
Trust makes a big difference. Yeah. And trust builds over
18:02
time as well. A first meeting often isn't enough for somebody
18:06
to say yes and work with this company. It does take time.
18:10
And, you know, what you learn
18:13
from some of these projects, and sometimes when you've paid
18:17
for a product, you find that you've paid and
18:20
they've disappeared and they've just left you with this. And so you need to know
18:24
that this company are going to stay with you and they're gonna support you
18:27
when there are problems. And so I think
18:31
what can they do in the first 10 minutes or what will turn you off?
18:33
I think if they talk just about immediately going into their sales pitch
18:38
of their product, then sometimes that switches people
18:42
off and showing lots of slides straight away. Actually, what you want them to
18:46
do is ask you what your problem is in
18:50
this area and how somebody could help you. And then you can work
18:54
on it together and get to them doing their pitch later. I think that's great
18:57
advice. I had David Thorne, who you're going to come and meet in the September
19:01
seminar. I was speaking to David last week and he said that exactly that.
19:04
Somebody come in to see him and he said within the first 5
19:08
minutes they'd opened their iPad. He said, and I noticed there were 45 slides
19:12
for them to take me through. He said, and they lost me straight away at
19:16
that point. It was gone. And, you know, and I think that's again really
19:19
helpful. Direction. And if I
19:23
take that a step further, if you had the opportunity to sit down with every
19:27
pharma, medtech, device company tomorrow morning,
19:31
what would you tell them that they kind of misunderstand about
19:35
primary care? What should they stop doing? And what should they start doing? If we
19:39
just take that a little further.
19:44
I think, I think Doing some homework beforehand,
19:47
I think, is helpful about that organisation,
19:53
because we are all run— we are all different. So as
19:56
alluded to earlier, some practices are partner-run,
19:59
some are now run by bigger organisations like trusts. So the way that
20:04
those practices work and the decision-making will vary.
20:08
So I think coming into that and understanding a bit more about that practice,
20:11
I think, is very helpful. And I think the
20:15
most important thing is listening and just spending a bit of time building that relationship
20:19
and understanding the problems that that organisation has,
20:23
or understanding a bit about their population that they look after. Yeah.
20:27
And so what we want to know is that they do
20:31
actually care about the patients. Yeah. And actually want to make a difference to patients,
20:35
patient care, and improve outcomes.
20:39
Yeah. As well as trying to make money from their products.
20:42
Yeah, it's what I call pathway over product. If you park
20:46
the path— the product to one side, when we come to see Dr. B,
20:49
I get my half hour with you, I come to see you, put the product
20:53
to one side and actually engage with you around where are your problems in this
20:56
particular area, no matter the disease area, where are the problems in your current pathways,
21:00
and then think about how I might be able to collaborate with you and
21:04
help you. It's moving from being a product vendor to being a pathway
21:07
partner. I think the NHS is looking for pathway partners. It doesn't need any more
21:12
product vending to them. Yeah, absolutely.
21:16
So let's imagine I've got a great innovation. I genuinely
21:21
believe it can improve patient outcomes. I've got 30 minutes with you, back to my
21:24
mythical 30 minutes in your diary. What should I do before I walk into the
21:28
room? And should I even have a first slide? And if I do have a
21:32
first slide, what should be on it? My advice
21:36
would be don't put the slides up straight away. Okay. They're there
21:40
if you need them, but the important thing is starting to talk.
21:45
And yeah, I think come to that. If your area is diabetes,
21:49
for instance, I'd like to see that you've gone away and checked what my,
21:52
you know, what my local practices are in Swindon. You know,
21:56
I'd like to hear that they've done a little bit of research into diabetes in
22:00
Swindon and what the problems are. Absolutely. And what we're struggling with.
22:04
And I'd like them to come and say, you know, what difficulties are you having
22:07
in this area? What would you like some help with? Where are the pathway difficulties?
22:11
And then start to talk about where their product might help. Again, I think
22:15
you've made a really interesting point there because one of the things, again, I would
22:19
talk about is discovery before design. In other words, if I don't
22:22
take the time to diagnose, which is what you do as a clinician,
22:26
you would look at the situation, you'll ask the patient lots of questions about the
22:30
background of why they're presenting here today. You'll then make an assessment, and then and
22:34
only then would you make a recommendation. So industry should be adopting,
22:37
for me, the same process. Discover before you start. Before I start telling
22:40
you where I can help you in your diabetes care, surely I
22:45
have to understand where the problems are currently. If you don't
22:49
do the discovery, for me, you can't do the design. And I think something I've
22:52
concluded a lot from my work is that the clinical value
22:56
will get you into a conversation. But I think the operational viability,
23:01
as in, is it viable operationally for us, is what would get
23:05
you adopted. So is that fair? And I think I know the one thing I'm
23:09
going to ask you, what's the other thing you would add? And I kind of
23:11
know the answer you're going to give me before because you've said it a number
23:13
of times on the way through. Yeah, yeah, no, absolutely. I do think that's fair.
23:17
But yeah, the additional thing is, and it always boils down to the funding,
23:20
who's going to pay for it? And I know that we've had lots of conversations.
23:23
In fact, I was lucky enough to be— I was up in the Highlands 2
23:27
weeks ago. So we're recording this at the end of August, so a couple of
23:31
weeks ago I was with, I don't know if you have come across him,
23:33
Dr. James Kingsland. James was a GP up in the Wirral and
23:38
he was a chair and president of the National Association for Primary Care
23:41
when I first got to know him 25 years ago, and we've become really good
23:45
friends over time and we're playing golf, which is my, you know, I'm not difficult
23:49
to persuade to play golf, and James and I were chatting about the development
23:53
and neighbourhoods because he's leading a big project up in the northwest for the regional
23:56
team just now. And the money was the thing that we spent more time talking
24:00
about— that where's the money coming from, who's going to fund it, how do we
24:04
pay for people to get, you know, time out to actually do stuff.
24:07
It's not about governance, it's not about meetings, it's actually about building trust
24:11
and working out where the money is going to come from to make the changes
24:14
that were going to happen. So I think that's a kind of recurring theme,
24:17
your thought about the money.
24:21
Yeah, and that's the biggest thing that often makes pilots,
24:25
projects not continue.
24:28
It's because if we can't work out how to fund them.
24:31
Yeah. One of the biggest issues is, you know,
24:34
we're talking a lot about prevention. Yes. And everybody
24:38
absolutely sees the real importance of prevention, both of
24:42
disease, both of admitting people to hospital, etc. But it's really
24:45
hard to move funding in order to move funding towards prevention where we
24:50
need to. So that's a real key thing of making
24:54
something successful, is how does— how do we move the funding from
24:58
everyday stuff in order to do some of this prevention work? It's really that.
25:02
Now, without us talking about the product at all or mentioning the
25:06
company, you and I had that conversation about a month ago, and interestingly
25:10
again, without saying where, I had exactly the same conversation with
25:15
one of the emerging, potentially emerging integrated health organisations.
25:19
And you know what was the most interesting aspect of that is they said pretty
25:23
much what you said. Don't disagree with it. Absolutely love the prevention idea.
25:26
I love the idea of optimising the patients. Yes, general practice
25:30
is the right place for this to happen. But who's going to fund the
25:34
work was the question that came back. And despite the fact that the hospital agreed
25:39
as a potential IHO, it's the right thing to do,
25:42
doesn't disagree with optimising them, doesn't disagree that it should happen in general
25:46
practice. The one thing that we couldn't agree on was how they would fund it.
25:49
So it stuck because the ICB is basically saying, well, we've spent all our money.
25:54
The hospital is saying, yes, we're an emerging IHO and that's what we want to
25:56
do, but actually we don't see that as our role yet, it might
26:00
come. So the prevention agenda, that whole bit, from the 10-year plan
26:04
about moving from treatment to prevention.
26:07
Somebody's got to invest in it or it's not going to happen.
26:10
Yeah, yeah, no, absolutely. And we've got a number of discussions going
26:14
on at the moment about work that could be moved
26:18
out of hospitals into primary care. But when hospitals are—
26:23
not all, but quite a lot are in deficit, actually, how do you
26:27
move funding out of that to primary care to do it,
26:30
but primary care can't manage to take on more without the funding.
26:34
Absolutely. But the funding has to come from somewhere to help support
26:39
us do it. You've taken me on to one of my hot topics, which is,
26:42
I always highlight, when I formed the consultancy in 2005,
26:46
you say that, it's like, it feels like yesterday, and it's, yeah, it's 21 years
26:49
ago. General practice had 11% of
26:53
the NHS budget. Today, it has somewhere between 8.3%
26:57
and 8.4%. Now I have mates who go, Scott, it's only 2.5%, and I'm
27:00
like, yeah, but 2.5% of the NHS budget
27:03
is about £5 billion, so £5,000 million.
27:09
Think about what that would buy in general practice today
27:12
if we still had the same level of funding. We would be able to take
27:16
on the left shift of work, we would be able to take on the single
27:20
point of access, and all of that would absolutely flow if only the
27:24
governments and the powers that be would actually properly invest back into general
27:27
practice. It's a real hot topic for me. It's the one I always go back
27:30
to. If you gave us the 11%, this wouldn't be a debate.
27:34
Yeah, I agree. I've got one last
27:37
question for you. So, Sarah, if someone from industry is listening to this just
27:41
now and they've got a meeting on Monday morning with the NHS,
27:44
what's the one thing— if there was one thing, what would you ask them to
27:48
do differently if they were coming to see you What would you ask them to
27:50
do differently? Oh, there isn't one thing,
27:54
but I think what we've touched on already, it's doing
27:58
a little bit of research beforehand, both on that organisation you're speaking
28:02
to and on the data around that condition
28:06
in the area. And then it's coming, not putting the slides
28:09
on, just spending a bit of time getting to know my problem and, you know,
28:14
where the issues are in the pathway. That's what I would like them to do.
28:18
Sarah, that's been absolutely fantastic. I can't believe how
28:22
quickly the time goes, but thank you for your insight. And can I ask,
28:25
if we needed you back, would you come back again? Because usually what happens is
28:29
we publish these and then I get a load of questions from industry, and it's
28:33
always done privately. They don't put them on LinkedIn for obvious reasons, but they
28:37
will message me. And if I get that, would you be happy to come back,
28:40
maybe answer some of the questions? I'd be delighted. Ah, thank you. Listen, thank you
28:44
again. An absolute pleasure talking to you, and I look forward to seeing you at
28:47
my seminar at the end of September. Looking forward to seeing you then as well.
28:50
Thank you. Hi everyone and welcome to the latest
28:54
Embedded Conversations, where this time I'm delighted to welcome Dr. Sarah Bruun
28:58
to the podcast. Sarah brings a really valuable perspective
29:02
on how decisions are actually made in primary care,
29:05
primarily because she's viewed the NHS from several different chairs
29:09
as a GP partner, a Primary Care Network Clinical Director, Federation Medical
29:13
Director, and she was previously the CCG clinical chair.
29:17
So that combination really means Sarah understands
29:21
something that industry teams can easily underestimate, that a
29:24
positive NHS meeting and adoption decisions are completely different things.
29:29
An idea can have really strong clinical evidence, enthusiastic supporters,
29:33
and an obvious patient benefit, but still struggle to move forward
29:36
once workload and the workforce and the clinical risk and governance,
29:40
finance, and all the accountability come into the conversation. So today,
29:44
Sarah's going to help us understand and get underneath the organisational
29:48
charts. We're going to understand what really happens after somebody says,
29:52
that sounds interesting. We'll look at who actually has authority
29:55
to say yes, who else you might need to involve,
29:59
what are NHS leaders silently assessing while an industry team is presenting,
30:03
and what separates a pilot that becomes business as usual
30:07
from one that quietly disappears. So today I'm going to explore with Sarah how
30:11
primary care adoption decisions are really made, the invisible filters
30:15
that shape them, and what pharma, medtech, and device companies need
30:19
to understand if you really want to move from good conversation to genuine
30:23
pathway challenge. Sarah, it is a real pleasure to have you on
30:26
the podcast, so welcome. Thank you very much. Thank you
30:30
for inviting me. I know I'm really looking forward to this as a conversation because
30:32
you do bring a very, very different perspective to
30:36
the party. So if I, if I
30:40
dive straight in, you've looked at NHS decision-making from several different chairs— the
30:45
partner clinical director, federation medical director, and of course from the CCG
30:49
clinical chair. So when somebody says the NHS
30:53
liked our idea, does that actually tell us very much? And what's
30:57
the difference between somebody liking an idea and then an organisation
31:00
really being prepared to adopt it?
31:04
So I think firstly, sometimes look at the NHS and think it is one
31:07
organisation, but it isn't. You know,
31:11
the NHS is made up of many organisations, from the ICPs that
31:15
do our commissioning. We've got hospital trusts that are separate organisations.
31:19
You've got community providers, and you've got GP,
31:22
GP at scale organisations like federations, and you've got individual GP
31:26
practices, and we're all separate organisations. Yes. So my first question is, well, who have
31:30
they spoken to? Which part of the NHS is that? And I think that's
31:34
a really good point because I often highlight to people— you're right,
31:38
by the way, Sarah, people from industry look at the NHS and see it as
31:41
the NHS. But the point I would make is patients don't see
31:44
it that way. So we've got all those different organisations, but that's
31:48
not how the patient sees it. The patient genuinely does see it as, well,
31:51
I'm going to my GP, or I'm going to the hospital, or I'm going to
31:54
the community provider. That's how they'll see it, but they experience their care through pathways
31:58
in reality. Yeah, yeah.
32:02
Sorry, you asked me a second part of that question. Yeah, sorry, the second part
32:06
was when somebody says the NHS liked our idea, it doesn't really tell us
32:11
much. What's the difference between somebody liking the idea and then you being
32:14
prepared to adopt it? What makes the difference?
32:20
Is, is that idea something that is solving
32:23
a problem for us? Yeah. Is it solving an issue in
32:27
a pathway? Is it going to make a pathway easier? And the big
32:31
question is always, where's the funding coming from? If today's conversation has struck
32:35
a chord, you'll love the Embedded Edge community. This is an online
32:38
platform for people who want to stand out with better positioning and
32:41
a deeper understanding of how decisions are really made inside
32:45
the NHS. With practical frameworks, real-world analysis, and behind-the-scenes
32:49
customer insights, you'll sharpen how you show up, engage,
32:53
and embed your work. So please join Embedded Edge at www.scottmckenzieconsultancy.com.
32:59
Thank you.