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Accelerating trust in primary care networks

Clarity of purpose, knowledge sharing and providing psychological safety can improve trust and relationships for collaboration in primary care.

Here’s a new way to fix the NHS money problems: every time someone says that trust and relationships are the key to collaboration they have to donate a pound.

If so, I’d be one of the main contributors. Having spent the past three years supporting primary care networks in Sussex, I’ve seen at first hand both the benefits locally based collaboration can bring, and that without trust, you’re stuck.

The challenge is that the perceived wisdom says building these relationships takes time, years in many cases. And we simply do not have years to make the changes required to create a sustainable NHS, particularly in general practice where we’re approaching crisis point. What gives?


Trust is a tricky subject for general practice. Often we’re talking about where it doesn’t exist: between practices as independent contractors, between providers and commissioners, or between clinicians in primary and secondary care. The pressures on general practice have made these tensions more acute, with practices increasingly competing for scarce staff, and clinical commissioning groups unable to match increases in workload with increases in funding.

Primary care networks will require a maturity of both trust and relationships to succeed – failure to cultivate these could mean these collaborations fall short.

The new primary care network contract offers a real opportunity, and crucially freedom of funding, for general practice to help overcome the distrust that these challenges can engender. The network approach can enable practices to retain the benefits of continuity of care for patients as well as gaining the benefits of collaborative working, including:

  • creating greater resilience by sharing staff, buildings and other resources
  • having access to a wider range of professionals and diagnostics
  • creating a more sustainable work/life balance, as more tasks are routed directly to appropriate professionals.

Given this, the ambitious timescales in the NHS Long Term Plan are likely to be challenging for many practices who may not have felt compelled to collaborate before in a meaningful way. But given the significant amount of funding that will flow through the new primary care networks, they will now need to reconsider collaboration. Primary care networks will require a maturity of both trust and relationships to succeed – failure to cultivate these, and fast, could mean these collaborations fall short.

Developing primary care networks

So how can emerging primary care networks accelerate their development? It’s questions like this we obssess about at Kaleidoscope, a social enterprise focused on applying rigour to collaboration.

Here are three practical places to start:

1. Make sure you are absolutely clear on purpose upfront and how it links to the day job. For many practices, primary care networks will involve giving up some level of control over their individual practice, needing to work with a wider set of partners with whom they might not be familiar. Merely citing national policy or contractual measures will not be enough to make this work. This is why the starting point has to be focused on the rationale for change. Take the time to bring people together to collectively clarify the purpose. Even if it seems obvious, it can highlight issues that collaborative working could address and improvements in key areas of pressure and workload; and can also surface long held assumptions or points of difference.

2. Create simple ways of sharing knowledge, information and collective discussion. Having a mechanism (which can be as simple as WhatsApp) for easy sharing, peer support and problem solving is essential for an effective network. For clinically focused discussion, daily huddles are increasingly used in primary care and can bring together practices, multidisciplinary teams (MDTs) and rapid response services within a network on a call to address and support those patients of concern that day, identifying a lead and action plan to prevent an unwarranted hospital admission. But don’t underestimate the power of physically bringing people together. Co-locating staff can be difficult so aim to create the space for face to face conversations and relationship building between partners through events, randomised coffee trials or our Melting Pot Lunch format. These enable stronger connections to be made across groups that may otherwise not have time to reflect in a psychologically safe environment.

3. Be clear that your network is an environment of psychological safety. There is a strong evidence base that networks thrive where people feel able to let their guard down and take risks without fear of negative consequences. This is most famously shown through Google’s multimillion dollar two-year study into team performance which revealed that their highest-performing teams have one thing in common: psychological safety, the belief that you won’t be punished when you make a mistake. As set out in the The Tactics of Trust by David Sawyer and David Ehrlichman, this doesn’t mean network members need to all like each other, or agree with each other on every issue – in fact, groupthink is to be avoided. But it is possible to accelerate the trust-building process through the creation of ‘trust for impact’, with primary care network members working to deliver a practical collaborative project that helps achieve their purpose, creatively managing their differences and forming relationships that enable them to deliver.

This blog was first published in Health Service Journal.

Clare Allcock14 October 2019