Challenges of finding time to prioritise service change

Chris Stockport, Clinical Lead Directly Managed Primary Care

Betsi Cadwaladr University Health Board


My Bevan Exemplar project was about finding ways of including substantial patient representation within the local decision making process of our innovative, health board-run primary care service.


It is so much more than a group of patients telling us whether they like ideas that we’ve come up with. The real reward for everyone is a council that can successfully share the ideas generation, the pain when making tough resource decisions and that can help our community explore the obligations that we all have as patients to make good lifestyle choices and use healthcare services prudently.

I think it’s really important. Yet I haven’t managed to get very far, despite working hard. I’m further along than I was 12 months ago, but it’s been slow progress - although I will get there.


Successfully delivering change within complex systems, is much tougher than you think, even with the great support of organisations such as the Bevan Commission.

The challenges will be different for others, but here are a few of mine…

  • General Workload: It’s been hard to find things to shift to allow time to undertake service change activity;

  • Priorities: This piece of work competed with several other changes relating to managed practices. Mid-way through the year I then unexpectedly inherited an additional managed practice, requiring lots of time. And clinical events through the year ended up taking priority too - "patient safety today" took priority over "patient safety tomorrow".

  • Politics: A couple of existing groups felt they should already be considered "the Council". It’s taken more time than I expected to work this through to satisfy them that they aren’t able to fulfil this role.

  • Personal pressures: Three children undertaking combinations of GCSE’s and A/S-level exams. Enough said!

  • I don’t get it: Never underestimate the power of other teams with-in large organisations to obstruct your work, particularly when you are innovating!


Never give up! I’m still moving the project forward, and we’ll get there, although with a longer timescale.

I’ve learned a lot in the last year about introducing change. And I will be continuing to share that learning within my own organisation, and in particular the absolute need to protect time and resource for those trying to innovate and spread change to improve services for our patients.

Part of cohort Bevan Exemplar Projects 2016-17