Driving Sensible Change in Primary Care

Creating an environment of innovation is a significantly different challenge to ensuring that innovation is adopted / change is encouraged amongst providers (GP Practice). While the two are interlinked, we’ve drawn out some key themes below that we think are vital to driving faster and more sustainable change at the provider level.

Driving change at ICB vs. practice level

There are a number of ICBs who have made concerted efforts to drive adoption of new technology in their localities, but these instances remain the exception rather than the rule. Generally, ICBs lack the internal capacity or appetite to meaningfully drive innovation or facilitate lasting change within practices.

Even when ICBs successfully initiate technology projects, closer scrutiny often reveals mixed outcomes. Initial results may appear promising, but deeper analysis often uncovers limited practical adoption and integration. Many practices either do not participate in ICB-led initiatives - even those without direct costs - or quickly disengage once ICB funding ceases.

For technology suppliers, working with ICBs can initially seem attractive, providing valuable exposure. However, this often involves navigating lengthy and complicated procurement processes, which are impractical for many companies. Additionally, if sustained revenue prospects (e.g. following pilot programmes) appear weak, suppliers become hesitant to rely on further ICB-driven pilots.

Fundamentally, the assumption that practices need ICB-driven change to innovate is misguided. In reality, most impactful and enduring innovations have originated directly within GP practices. Prominent market leaders in every class of GPTech tools demonstrate that direct engagement with practices is an effective route to rapid, meaningful, and sustainable change. Practices themselves are best positioned and most genuinely incentivised to drive innovation, as improvements directly benefit their operations, workload, and overall business efficiency.

Embrace and adapt to market forces, rather than swimming against them

Adoption of new technology or systems within Primary Care follows a predictable pattern, aligned closely with the Technology Adoption Life Cycle (see here). We've identified five distinct 'Cohorts':

1. Innovators – Practices willing to adopt cutting-edge technologies even before full maturity.

2. Early Adopters – Relatively innovative practices who adopt technologies once they're nearer to maturity, setting an example for broader uptake.

3. Early Majority – Practices motivated by demonstrated benefits and the fear of missing out, quickly following the innovators and early adopters.

4. Late Majority – More conservative practices that adopt technology primarily to mitigate risks of falling behind or attracting regulatory scrutiny.

5. Laggards – Practices resistant to change, often adopting only due to legislative or contractual mandates.

   
   

Building a change system reliant primarily on cohorts 4 and 5 is inefficient, as these cohorts naturally follow the precedent set by cohorts 1, 2, and 3. Effective change strategies should instead prioritise facilitating adoption by cohorts 1, 2, and 3, subsequently supporting cohorts 4 and 5 to follow.

For Cohorts 1, 2, 3, facilitating practice-led adoption is key. Given their natural inclination towards innovation and their self-starting nature, this will be best facilitated by simply creating an environment where good innovations can thrive (as described above). Where great technology exists, Innovators and Early Adopters (Cohorts 1 and 2) will find it, and the Early Majority (Cohort 3) will quickly follow.

For the Late Majority (Cohort 4), targeted support at local and national levels is essential. This can include accessible technology catalogues, informative case studies, helpful webinars and training sessions, direct facilitation and encouragement. This approach differs from centrally mandated, ICB-led solutions; instead, it empowers practices to adopt technologies independently, with support tailored to their specific needs. This supportive approach is already in place in many areas, with ICBs working closely with practices that lag in key operational areas.

Where practices are true ‘Laggards’ (Cohort 5), commissioner or regulator-led intervention is key. These could range from financial incentives or penalties to regulatory actions in situations where non-adoption significantly affects patient outcomes. Historical examples include practices resistant to digital clinical system implementations, where targeted regulatory and contractual/financial interventions proved effective.

The role of the ICB should focus on facilitating learning and best practice sharing, providing targeted support to struggling practices, rather than directly commissioning technology solutions. This mirrors the broader operating principle that commissioners support but do not directly manage internal operations.

Enhance operational incentives for practices in primary care

Operational outcome incentives are a critical driver in encouraging GP practices to adopt innovative tools and improve patient outcomes. While that is a broad topic with considerations around the GP contract and the fundamental relationship between contract holders and the NHS, the fundamental point remains clear: practices require compelling incentives to motivate changes in behaviour and improvements in standards. If they don’t have this, then they are unlikely to adopt tools that help them to make those changes.

QOF offers a clear example - many practices express frustration with QOF, seeing it as burdensome and not necessarily effective in driving meaningful outcomes. However, the underlying issue often lies in the complexity and effort required to achieve QOF targets. Practices may find it easier to receive unconditional income rather than investing additional effort to meet specific conditions.

Evidence from Scotland, where QOF was discontinued, shows a clear and sustained reduction in recorded quality of care. Rather than abolishing QOF, the framework should be refined and adapted to become more relevant, comprehensive, and effective. A well-designed QOF (or similar incentive scheme) would encourage practices to consider technologies like Hippo, which significantly streamline workload, enabling practices to achieve higher standards of care more efficiently.

In broader contract terms, while flexibility in GP contracts is beneficial, it does not necessarily lead to improved patient outcomes unless supported by clear incentives or robust regulation. Strengthening the role of commissioners, regulators, and contract stipulations would encourage practices to proactively seek out and adopt innovative solutions, ultimately leading to better patient care and operational efficiency.