You Cannot be Half Pregnant!

Yes, I know it’s not a clinical condition. I also know there is no such thing as being half pregnant and yet I see it most days in my working life. What I am getting at is that you cannot be pregnant (engaged) when it suits and not pregnant (disengaged) when it suits (half pregnant). Whether it is engagement with a Primary Care Network, a GP Federation, the CCG, the Integrated Care system or any other stakeholder, you are either fully engaged or you are not. What you cannot be is half hearted and only engage when it’s of interest to you; that is a recipe for disaster if you are trying to develop a Practice, Network or Federation.

Whatever you are required to engage with, people have to come with a mindset that they are prepared to negotiate and compromise to get an outcome that everyone believes is fair and workable. To be clear nobody is going to 100% of what they want all the time. I have an 80%:20% mindset, where I anticipate getting my ideal 80% of the time and I’m prepared to negotiate and compromise on the other 20%. Without a willingness to negotiate (give and take) we end up with negotiation breaking down and everyone loses in that scenario.

You should also highlight that everyone will be involved in the conversations about what the future will look like; this is why you are engaging with them. That way people have the opportunity to own the problem and the creation of the solution. With ownership you get implementation and are more likely to achieve the outcomes you want. Without ownership you are likely to get resistance to what is viewed as top down command and control and, of course, this leads to people resisting your ideas.

If you work openly with your teams and keep them updated in general about progress being made you address a lot of the fears people have and prevent problems and you avoid people becoming half pregnant.

In using this approach, I now have areas I work where we are putting the joy back into General Practice. Everyone is engaged behind one common vision they want to deliver. If/when they see people becoming half pregnant, they stop and challenge them. They are either all the way in (fully engaged) or all the way out (not engaged at all), but they cannot be halfway in/out at any time. The strong preference is that people are in and actively engaged in pursuit of the strong, resilient and sustainable General Practice.

If you want to develop a business ready at scale provider organisation, Primary Care Network, GP federation, Super Practice, PCH or ICS, or are about to deliver any form of change, and are looking for a model to engage every stakeholder in that change, and would like more information on how Scott McKenzie UK Ltd can help and support you please contact please Frances on 0845 388 0302 or email

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