Anyone who wants to scale up successful pilots in a complex administrative environment, must continuously learn and adjust to involve all relevant parties and create a willingness to take action.

Intention

A shift of second- to primary care for children with ADHD led to a lot of commotion among general practitioners. And speed is of course crucial in communication? The doctors did not consider themselves competent enough to treat this group adequately and they would not have enough time. A new approach was therefore urgently needed, where the GP would be relieved and the youth would be better helped. The answer turned out to be a pilot with a practice nurse GP (POH)-Mental Health Care Youth, which was tested in the region of care group Syntein. Zorggroep Syntein is an organization for chain care of a cooperative of general practitioners.

Approach

We started on a manageable scale and in 2017 first did a pilot with a POH-GGZ Youth in a large general practitioner in a small municipality. This was very successful: GPs happy, childhood happy, and visible cost savings for the municipality. Other municipalities and general practitioners in the region had also become enthusiastic and wanted to start with a POH-GGZ Youth.

Result

Making joint agreements within a region with 65 GPs and six different municipalities turned out to be extremely complicated. You don't just get noses in the same direction. For example, the local organizational contradictions are quite large and there are significant cultural differences between municipal authorities- and healthcare domain. Administratively, it appears to be chaos in some municipalities, especially just before election time. The delusion of the day then prevails. The pilot in the first municipality was hugely successful, but the responsible policy staff turned out to have a lot of difficulty with extending the POH-GGZ for 2018. There were also municipalities in which the policy officers, but the GPs in particular were difficult to convince of the usefulness of a POH-GGZ Youth for both patients and themselves.

After a remarkable consultation between general practitioners and municipalities, where just about all archetypes that IvBM provides were passed by, have we managed to set up a POH-GGZ Youth in two municipalities for the time being. The other (cooperating) municipalities were still too divided for that. There, the plan was put on hold until after this spring's elections and a 'regrouping' of GPs in the course of 2018. However, there is no alternative plan. It is expected that POH-GGZ Youth can still be set up in several municipalities with better coordination.

Lessons

As a general practitioner you gain a lot of knowledge about the municipality, not just as an organization (the hierarchy and the jargon, for instance) but also as a cooperation partner and about the general practitioners as a group. It is instructive to know what should and should not be done to be able to further roll out a pilot. Timing becomes your best friend.

1. It is now clear how you can get colleagues on the same page, although sometimes you have to try not to always want that. You can also turn off the lines yourself and serve bite-ready. In addition, it may be better to have GPs represented by one person with a clear mandate;
2. Sometimes you just have to sit around the table with not too many people, but first make an inventory and only then make decisions with a delegation (GPs in this case);
3. It is important that municipalities do not, but approachable more as a collective, and then sit around the table with the employees with the most knowledge. That is not always the alderman, by the way;
4. Try to recognize and take into account the cultural differences between municipalities and healthcare professionals.

Name: Saskia Benthem
Organization: care group Syntein

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