This is one of the busiest times of the year for the PCT. We have a tight timetable to assemble a plan and start contract negotiations. Soon we will be given an operating framework. We are given a lot of central direction and this year part of that is called QIPP; we have to have a QIPP plan. The regional QIPP plan has 8 themes, which make a lot of sense. Each theme has a number of projects attached to it. In fact, there are 34 projects encompassing specifics such as getting COPD care right, through to “Right Care” which, in reality, is a massive programme of work on its own. We are accustomed to this way of working and will marshal the evidence to assure the SHA, who have to assure the DH that we are paying attention to all 8 themes and 34 projects. There is, however, a new twist. Now, we also have to assure the SHA and the DH that GPs are “fully engaged in QIPP.”

I was re-reading Paul Plsek’s chapter in Crossing the Quality Chasm this week. A decade after publication it remains totally relevant. He talks about complex adaptive systems and reconciling mechanical and adaptive systems thinking. He articulates the difference between the macrosystem and the microsystems contained within it. It got me thinking about QIPP and GPs.

When I started as a GP, I learnt from my partners how important it was to organise your consulting room so that you could put your hands on what you needed when you needed it. Since then I have observed that the best practices are also the best organised. The analogy I draw from this is that QIPP is only a set of tools. We can forge and shape the tools which professionals, in their workshops, need in order to address an individual’s problem. However, critically, the most important thing is how they organise their workshop so they can lay their hands on the right tool when it is needed. If I dump 34, or even 10, projects on each of the 102 General Practices across Lincolnshire, I doubt if we will get the result the SHA and the DH want.

So is QIPP irrelevant? Not at all. There is a ninth theme which is not centrally directed. It is labelled ‘other local schemes’. In my view, the other local scheme is about creating a narrative, providing feedback and information which will focus consortia on getting their workshops in order, so they can find and use the tools the QIPP process has created. This is a massive challenge – it requires the transformation of General Practice from a set of individual businesses into a co-ordinated network working with a common purpose. If we don’t pay attention to this ‘other local scheme’ then we will end up with the quip Samuel Johnson used to describe Strategic Planning in 1753; “It is well known, that many things appear plausible in speculation, which can never be reduced to practice; and that of the numberless projects that have flattered mankind with theoretical speciousness, few have served any other purpose than to show the ingenuity of their contrivers.”

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.