GullRun Health Services are an independent healthcare provider, established as a Community Interest Company (CIC) who are looking to move away from their current business model, which is heavily dependent on NHS (National Health Service) commissioning.
GullRun want to move away from this model in order to establish a more visible presence in their local area, and also to avoid the significant payment lags that they are experiencing on many of their contracts - in some cases, it has been over a year since the service they were commissioned to provide started seeing patients, and they still haven’t received a single payment from the NHS. This is obviously having an impact on their ability to maintain a prudent level of reserve funding, and preventing them from addressing pressing healthcare needs within their communities.
GullRun Health Services approached The Productive Pessimist Ltd, and requested a supported session working through The Productive Pessimist Performance Plan, at a cost of £85 for the ten members of their Leadership Team. GullRun’s CEO, Jonathan Roby, admitted that a significant challenge for the Leadership Team was getting consensus on what areas to focus on within a remit to move away from NHS commissioned services.
In Jonathan’s own words: “There are simply so many things going round in peoples’ heads, we just end up talking about doing a lot, and then don’t actually do anything! It’s actually like that with the teams here, too, when they’re focusing on their various projects, and ways they could be more efficient - a lot of good quality conversations, but no real action.”
Ash, who focuses on corporate provisions for The Productive Pessimist Ltd, is very used to companies facing this exact situation - people tend to have very little difficulty identifying what’s wrong, or coming up with ideas on how to improve it, but the ‘comfort zone’ for many professionals is ‘having meetings about things’ - actually identifying and taking specific actions can feel like a very big step outside that comfort zone!
Ash’s first step was to identify how GullRun preferred to work, so that he could help tailor The Productive Pessimist Performance Plan to their process, and ensure he wasn’t letting something that would actually require three months to be signed off be identified as an immediately-accessible action. GullRun identified that they worked in an agile way, and expenditure below a certain amount did not need to be signed off, unless it involved a wide-scale business impact. This fitted very well with the way The Productive Pessimist Ltd also works, and made for a very harmonious, and mutually comprehensible session.
GullRun wanted to use The Productive Pessimist Performance Plan as a basis for a 12mth plan, with each ‘fail point’ being given an eight-week targeted action period, with fortnightly ‘show and tell’ checkpoints to maintain accountability for progress. Ash felt this was a very good use of the Performance Plan, and one which would not overload an already busy workforce. It recognised that the change needed to happen, and couldn’t take too long, but it gave people time to become accustomed to what was happening.
Working together, GullRun Health Services and The Productive Pessimist Ltd identified the following ‘fail points’ to work on:
1. GullRun haven’t challenged NHS England over non-payment
2. GullRun have neglected full integration of new teams, such as the Transformation Team, with existing Operational and Frontline teams
3. GullRun have not ensured protected time to generate and build new business concepts
4. GullRun tend to underestimate the costs of launching new concepts, which has caused a wariness within the business, as many staff have recollections of previous ‘bright ideas’ which have failed
5. GullRun are too tied to the NHS ‘Banding’ concept, and this is limiting Leadership’s recognition of the company’s strongest ‘ideas people’.
Ash suggested that each ‘fail point’ was taken on by two members of the Leadership Team, as this would enable ideas to be ‘bounced around’ without creating too much noise and distraction, whilst also not overwhelming the Leadership Team as a whole by challenging them to solve all five fail points. This was very enthusiastically agreed by GullRun, and the process continued as followed:
Fail Point 1: Actions:
1. Issue formal communication to NHS England that GullRun will be limiting our exposure to commissioned service provisions from (2025), and, this being the case, we require all currently commissioned provisions to be paid up in full within 90 days.
2. Clearly state tolerable payment terms for companies (90 days, with discounts for payments within 7, 14, 30, and 60 days), and make clear that individuals are required to pay in full at the time of booking. (Refund policy also to be decided upon.)
3. Company-wide communication, via SystmOne cascade, email, team meetings, and company webinar, that we will be moving away from NHS commissioning, into more dynamic, entrepreneurial healthcare provision, which is relevant to and needed in the local area.
4. Identify service partners who are already active and embedded.
5. Challenge each of our Operational teams to generate at least one concept for future provision, with a short-form business plan accompanying.
Fail Point 2: Actions:
1. All members of the Transformation Team to spend one day per month shadowing Operational teams, and Operational leads to spend one day per month each with Transformation Team
2. Transformation Team to proactively engage with Operational teams, rather than waiting for Operations to have a ‘problem’ they want ‘fixing.’
3. Transformation Team to be proactive about publicising what they are doing for and with the company.
4. Business Ops meeting to include a dedicated section for Operational leads to ask for Transformation input/guidance on issues they are facing
5. Transformation Team are made the ‘internal public face’ of problem-solving within the business.
Fail Point 3: Actions:
1. Require all non-frontline staff to be in-office Fridays from 8.30am-4.30pm. Friday afternoon is ‘concept creation’ time, starting with lunch being provided to the office at 12.30pm. This protected time runs until 4.30pm.
2. Set 10minutes at the end of every meeting for ‘ideas throw in’ (we have a LOT of meetings! This should give us plenty to begin working with!)
3. Allow staff to take 2hrs per day as protected time to focus on working up new concept ideas, etc. This is identified by staff, rather than requested, and is seen by all as an immovable commitment - this is cascaded from Leadership to reinforce importance.
4. Extend the monthly webinar to include a contributions section for draft-planned business concepts
5. Establish a dedicated Business Development role, and identify in-house talent to serve this position.
Fail Point 4: Actions:
1. Leadership to conduct thorough research into actual costs.
2. Percentage of company budget to be ring-fenced for new business, so we know what we have to work with.
3. Identify what we’re already doing that we could sell on the open market - tidy up relevant website pages, blast out on socials, local engagement, etc.
4. Provide protected time for Operational teams to go into the community, and identify the actual needs, so we don’t end up throwing money at things which aren’t wanted.
5. Require all business plan drafts to include evidence-backed, source-supported costings.
Fail Point 5: Actions:
1. Instead of the Banding being exclusively pay-grade, link it to how many decent ideas individuals in each Band are expected to contribute to the business each quarter (The Bands are numerical, so this is actually an easy link; need to look into how to do it legally, or if it’s just a ‘social construct’ that we really hype up and embed. Eg, Band 8s are expected to generate 8 decent ideas in a 3-mth period, Band 4s 4 decent ideas, etc)
2. Appraisals should start with ‘what would your ideal day at work look like?’
3. Whenever higher Bands delegate down, they also have to recommend the lower Band colleague they delegated to for at least one advancement opportunity.
4. Bands 4 and below each get priority shadowing of Operational Leads and Leadership Team
5. Band 4 is the first ‘leadership’ band (this is actually reflected in most NHS settings); their roles will include office administrators, project managers, etc. Band 3 are the support roles for Band 4s. Band 5s’ focus is on encouraging and enabling Band 4s to develop skills, confidence, and competence - this is mandated, cascaded from Leadership, and held to account in Appraisals, which become 360 experiences.
It was agreed to consider the potential ‘derailers’ solely for GullRun’s intention to move away from NHS commissioning, as to proceed through the full plan with it would take a considerable amount of time, and risk the very thing GullRun had already identified as a problem - getting caught up in talking about doing, and never actually finding time to go and do.
Derailers:
1. Hostility/refusal/legal challenge from NHS England
2. Unsettles people in the business, leading to retention challenges
3. Potential impact on how we recruit, and our options for doing so
4. Financial risk
5. We discover the people we have simply aren’t able to perform as we need them to for this role
Worst-Case Scenarios:
1. We’re unable to proceed with this intention owing to legal barriers
2. We end up below minimum strength, and are unable to survive as a business
3. Similar to above, including that recruitment becomes more expensive and time-consuming, as the talent we need just doesn’t exist in the local area
4. We use up all our reserves launching new initiatives, and NHS England does not approve our request for full and final settlement.
5. We have to ‘row back’ on our intention to move away from commissioning until we can recruit the right kind of people; this means we look weaker in the eyes of NHS England, and makes it even less likely they will prioritise settling their accounts with us.
As you can clearly see, the ‘worst case scenarios’ for GullRun were pretty severe, in many cases. Following coaching-led conversations with Ash from The Productive Pessimist Ltd, it was decided that the lowest-risk actions were:
. To centre the Transformation Team as ‘the business’ problem-solvers’, and promote them to the business appropriately (Gary Rowan, head of the Commercial Directorate, under whose control the Transformation Team sits, decided they would be referred to as ‘The Company Pitbulls’ - “they’re friendly and fun when you make time to get to know them, but they’ll tear the hell out of anything bad that comes near the business.” This was widely greeted as a fun, relaxed form of re-branding.)
. To identify pay Bands with a responsibility for ideas-generation; this was decided to be an informal, ‘company culture’ attitude, with no penalties for not meeting your Band expectation. Finance would be given the final decision on which ideas were taken forward to launch, and GullRun would prominently identify the Band each of those ideas had come from.
. To identify existing provisions which could be made into public offerings, and promote them professionally and effectively.
. Operational Leads to carry out research in the community to discover what is needed and wanted locally, and what a tolerable price point for the local community would be.
These four actions are straightforward to implement, and will go a long way towards both solving some of GullRun’s problems, and to helping steer the business towards the most suitable expansion ventures.
GullRun opted to retain The Productive Pessimist Ltd as a ‘Critical Friend to the Business’ for six months, at a cost of £4,000, to support them as they worked through all of the action points they had identified with Ash’s support.
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