These topics plus much more will be covered on the North Cumbria GP Update Course!

We’ve got a wealth of topical updates for you as well as the usual treasure chest of drug dilemmas, minute memory joggers and our new GEMS. Why not book your place safe in the knowledge that you needn’t do another thing to get up to date. 

What can you expect?

Dementia: We'll look at the new NICE guidance from 2018, consider what ‘timely diagnosis’ looks like for our patients and how best to maintain and manage independence. We'll consider the ‘best’ screening tests to use and who to use them in, the role of cognitive stimulation and reminiscence and when drug treatment should be offered. We also look at how to manage associated problems like depression, sleep disturbance, aggression and agitation. 

Spotting cancer early remains high on the agenda. We consider when weight loss is significant and how other markers of possible occult malignancy, such as raised platelets, might help us spot cancers earlier. 

ENT: We offer some nuggets of gold (not ear wax!) – how to assess and manage hearing loss, when and how quickly to refer and does anyone actually need antibiotics for otitis media? When is face pain sinusitis – and what else could it be – midfacial segment pain anyone? 

Bread and butter primary care dilemmas: We look at how we spot the minority of patients with neck pain who need referral for imaging, how we can improve care for itchy grumpy children with eczema (hint: a written self-management plan could be key here!), how ‘not to miss’ our once a career diagnosis of Addison’s disease and important primary care management tips for these patients - plus the much more common group with adrenal suppression - those on long term oral steroids.

If that’s sparked your interest, then be sure to book your place on the next course:

North Cumbria GP Update Course, Thursday 17th January 2019, 9.30am - 4pm

The Samuel Lindow Building, Westlakes Science & Technology Park, Ingwell Drive, Moor Row, Cumbria, CA24 3JY

The Health Foundation is looking for 18 senior health care leaders from across the UK to join their leadership programme GenerationQ. 

GenerationQ is an 18-month part time, funded leadership development programme for senior leaders in clinical and non-clinical roles from across the UK, representing the wide variety of sectors working in and with the health service, including provider, commissioner, policy, regulatory, third sector, local authority and charitable organisations. 

This is a unique opportunity for you to gain a postgraduate academic qualification, enhance your leadership and quality improvement skills and develop your organisation’s capability for quality improvement.

The fellowship is delivered in partnership with Ashridge Executive Education at Hult Business School.  

The ninth cohort will be the final round of GenerationQ, so please apply and share with colleagues and friends. The insights the Health Foundation have gathered from everyone who has been a part of the programme will prove invaluable over the coming year, as they consider new ideas and approaches to support leaders of health and social care.

If you are interested in applying for GenerationQ, please read the Call for applications document and all supporting information about the programme on the Health Foundation's website.

Deadline for applications is 12 noon, Monday 14 January 2019. 

If you have any questions about GenerationQ, please email: 

Find out more and apply

Do you know, North Cumbria Library and Knowledge Services (LKS) can help save you time and improve communication within your team?

Find tools and techniques to share what you know and learn from others: 

The tools help staff to learn before, during and after everything that they do so that best practice is replicated and pitfalls can be avoided. The tools introduce eleven techniques to help plan, co-ordinate and implement knowledge mobilisation activities. Or you can access e-learning

For more information see the Library website or follow North Cumbria LKS on Twitter @NorthCumbriaLKS



By Rachel Fleming, Clinical Programme Manager CLIC

CLIC have been using a tool to understand inter-team dynamic better for the last 2 years. We have tested it out with some willing teams, and have found it to be useful in understanding where issues arise and in helping to address the issues. CLIC have been funded by the Health Foundation for this work as we are the first area in the NHS in England to use this framework.

The framework is called Relational Coordination (RC). Not a very catchy title I know, but it does describe what it is, which is a framework to help teams become better coordinated in their work through thinking and addressing the relationship side of the workplace. RC is used widely around the world in healthcare, education, airline business and in manufacturing. There is a growing evidence-base supporting this approach to care. A recent King’s Fund publication reporting on the first wave Integrated Care Systems opened with the quote: 

“Transforming systems is ultimately about transforming relationships among people who shape those systems. Many otherwise well intentioned change efforts fail because their leaders are unable or unwilling to embrace this simple truth”

(Senge et al 2015)

So what is it?

Relational Coordination is a framework which is all about communicating and relating for the purpose of integrating our work. The framework identifies 7 evidence-based elements that make work processes and pathways more coordinated from a relational perspective. These elements are:

These elements are found to matter most where work processes are complex and interdependent, uncertain and time constrained - I am sure this sounds very familiar. The way we work between teams is of significant importance to pathways of care where we are working with multi-professional groups, sometimes in different organisations. If we think about the average referral for a diagnostic test, for example: there is a GP or hospital doctor as referrer, the administration team who receive and process the referral, the technicians who implement the test, the specialist doctors who interpret the findings, and the service user themselves who turn up when they are asked to and experience all the links in the process. All these groups need to work in a coordinated way together to ensure the service user gets what they need. The correct and right amount of information needs to be given at each stage so the next person can perform their task effectively, otherwise delays occur while information is bounced back and forth. Each group of professionals needs to be trusted to do their bit, or work arounds are created and duplication of effort takes place 'just to make sure'. 

We may feel we have good relationships within our teams, but how much do you really know about the work of the other teams your service users come into contact with? Do you know enough to make sure you can communicate with them in a timely way so as not to hold them up or put pressure onto their work area?

The impact on performance where teams work in a highly relationally coordinated fashion has been seen in a number of areas including staff and service user experience, quality and effectiveness of care delivered and efficiency and productivity of care delivered. 

We have tested this framework out using the survey tool that sits alongside it, and the information it generates is really useful to enable teams to have a different conversation about how to improve their work. It moves them away from only focusing on technical and process/pathway fixes into thinking about behavioural and adaptive approaches too. The combination of both leads to improved outcomes and better inter team working. 

We are also using RC within team development to make staff aware of the elements and help them to identify where improvement around specific elements can take place.

We think this is a really useful framework to use with teams and have found it to be very intuitive to understand and grasp. We were recently asked to feedback to the Relational Coordination Roundtable Conference about the work we have done and our findings:

We would like to help more teams understand and use this framework to improve our work processes and outcomes.

If you would like CLIC to help you to understand your team better and those you work with please get in touch via: 

You might also be interested in attending one of our 'Understanding Teams Better' Bitesize Sessions - find out more and book your place via: 

Did you know?

CLIC offers one-to-one coaching support to leaders across the health and care system in North Cumbria.

We have recently trained nine additional coaches, bringing our coach community up to a total of eighteen, who will support our leaders in the challenging work of improving our services for our local population. We are working with the North East Leadership Academy (NELA) to ensure our coaching maintains professional and of high standards.

If you are interested in receiving coaching to support you in your work, please contact: / 01768 245480