Over the past year, Xytal have been working alongside Suffolk and North East Essex ICB on a programme focused on one of the most persistent challenges in the system: the Primary Secondary interface. The point where patients move between GP practices and hospital services. Where delays, duplication and frustration are often felt most acutely.
What stood out quite quickly was that this was not about a lack of insight. People on both sides already understood what was getting in the way and what needed to change.
What was missing was the space, momentum and shared ownership to turn that understanding into something that could actually move.
So the focus shifted away from more reports and documents, and towards how progress could be created in practice.
Starting with relationships
At the heart of the work has been the Senior and Aspiring Leader Leadership Programme, bringing together clinical leaders, system partners and frontline staff from across primary and secondary care.
We spent time rebuilding working relationships across the interface. Creating space for honest conversations. Surfacing frustrations. Reconnecting people who, in many cases, had little opportunity to work together before.
That might sound simple, but in a system shaped by pressure, specialisation and constant demand, those connections are often the first thing to break down.
Claire Fuller captured this clearly when reflecting on the interface and the ambitions of the 10 Year Plan:
“We just do not know each other anymore. And actually, that is to the detriment of delivering patient care.”
Rebuilding that understanding has become a thread running through the whole programme.
Leadership as a practical lever for change
One of the strongest messages from the early stages was that the interface challenge is cultural and behavioural, not just operational. So the programme has focused just as much on how leaders show up as on what they do.
Participants are working on real challenges from their own services, supported by continuous improvement methods, action learning sets and coaching. They are tackling issues they can influence directly, rather than developing theoretical models.
There are currently 11 projects underway involving around 50 people. Each one is deliberately narrow and manageable, focusing on areas such as advice and guidance, emergency pathways, women’s health, children’s mental health and diagnostics.
Blending disciplines
An important part of the programme has been the way different disciplines have been brought together.
Process science, behavioural science, digital expertise and frontline operational knowledge are working side by side, rather than running in parallel.
A good example of this is the accountability chain that underpins the programme. Participants move through a repeated cycle of:
- Plan
- Do
- Take stock
- Recalibrate
- Do
- Celebrate
It brings structure without becoming rigid. Support without creating dependency, and keeps the work grounded in action, not just intention.
We have also drawn on ideas from outside healthcare, including hackathon style events and leadership pods inspired by the technology sector, as practical ways to accelerate problem solving and sustain peer support over time.
Why digital only works when relationships do
Digital has come up again and again through this work.
Many interface issues are made worse by systems that do not speak to each other, unclear decision making and what clinicians often describe as faceless communication.
However, the programme does not treat digital as a separate strand. Instead, it reconnects it back to how people work together day to day. Who needs to speak to who. Where clarity is missing. How responsibility is understood and shared across organisational boundaries.
Restoring digital value is as much about restoring trust and visibility as it is about improving platforms.
Measuring what matters
From the start, evaluation has been part of the design rather than something added on later.
- Real improvement plans being completed
- Changes in leadership confidence and capability
- How ready projects are for implementation
- And early signs of smoother patient journeys across the interface
While it is still early to report firm financial figures, the expected benefits are clear. Fewer duplicated investigations. Better discharge planning. More effective referrals. Less rework across the system.
And just as importantly, a more connected leadership community that can keep improving beyond the life of the programme.
What this means for integrated care
This partnership has reinforced something we see time and again across the NHS. Integrated care does not begin with structures, but instead with how people work together. How supported they feel to challenge and change, and whether the system creates space for shared ownership, not just shared plans.
The Primary Secondary interface will never be fixed by one project or one programme. But this work with SNEE shows what becomes possible when leadership, improvement and relationships are brought together around a shared purpose.
We are thrilled that the partnership between Xytal Health Management and Suffolk and North East Essex ICB has been shortlisted for the 2026 HSJ Partnership Awards, recognising Most Effective Contribution to Integrated Health and Care. It reflects the commitment and energy people across the system have brought to this work.
