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Guy’s and St Thomas’s NHS Foundation Trust (GSTT) provides a full range of hospital and community services for people in three London boroughs, as well as enjoying an international reputation for specialist care ncluding cancer, renal, orthopaedic and cardiovascular services. It employs around 16,000 staff and has an annual turnover of £1.5 billion, with more than 800,000 patient contacts per year in community services alone. In 2015, in response to long-standing staffing and quality challenges, and inspired by the example of Buurtzorg in the Netherlands, GSTT secured funding from Health Education England and commissioned Public World to support a ‘test and learn’ initiative to provide holistic services through self-managed teams in Lambeth and Southwark.

Through a series of workshops with senior managers and frontline nursing staff, we co-designed the project and established a working group drawn from GSTT itself, social care leaders in the two boroughs and other stakeholders, including our representatives. We organised a study visit to Buurtzorg and arranged learning and development support for the initial members of the self-managed teams and their coach. We also ran a workshop to support the management’s thinking about the changes required to enable the teams to be well supported by the Trust’s administrative services.

Evaluation by a renowned academic team led by Professor Vari Drennan, MBE, director of the Centre for Health and Social Care Research at Kingston and St George’s, reported “high levels of satisfaction” among the people served by the teams and “positive care outcomes” reported by other health professionals in the locality. The team members also reported that “satisfaction in their work came from positive patient feedback, from positive feedback from GPs and other health professionals and from working together collectively to provide the service”. However, “while the ‘team and delivery’ was seen to be working well, all interviewees in different ways pointed out that ‘the headaches are the organisation itself’. Some interviewees reflected on the readiness of the wider management cadre and administrative and support departments to embrace the concept of self-managing team