My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

Read my statement in full »

How CCGs can stick to their mandate and develop patient-led value for the NHS.

Filed Under (Clinical Commissioning Groups, GP Commissioning, Health Improvement, National Commissioning Board, Patient involvement, Self Management) by Paul on 21-11-2012

This evening, at about 18.15, I am speaking to the NHS Alliance conference in Bournemouth. My theme tonight, as it has been for some time now, is how the NHS can develop better public value by viewing people with long-term conditions as ‘assets’ rather than as ‘costs’. Read the rest of this entry »

How commissioners can develop new value with the NHS

Filed Under (GP Commissioning, Patient involvement, Reform of the NHS, Self Management) by Paul on 30-10-2012

This morning I will be on the platform at the beginning of the National Association of Primary Care’s (NAPC) conference talking to one of the two GP organisations that have helped develop GP led commissioning. I am one of four speakers speaking on the theme of “Transforming the NHS”. Unfortunately for the NHS, transformation is a topic that has been much discussed but rarely put into practice. Read the rest of this entry »

For the NHS the big question is can the number of referrals from GPs to secondary care be reduced?

Filed Under (Clinical Commissioning Groups, GP Commissioning, Health and Social Care Bill, Secretary of State) by Paul on 25-07-2012

…for the Secretary of State it’s, can he claim that his policies have made this happen?

Last week the HSJ revealed an analysis of figures that showed that the recent national downward trend of GP referrals had returned to its historical upward trajectory. In fact the current peak of referrals from GPs is now higher than its previous highest point. This is bad news for the NHS since it shows that current attempts at managing the demand for secondary care do not appear to be working. . Read the rest of this entry »

Mandating NHS reform: – the new world according to Andrew.

Filed Under (Clinical Commissioning Groups, GP Commissioning, Reform of the NHS, Secretary of State) by Paul on 09-07-2012

This is an exciting week for me! (I know, it’s sad but I live in a small world).  My first three posts this week will reflect on different aspects of the draft mandate for the NHS that the Secretary of State launched last Wednesday, and on Thursday I will review Nick Timmins’ publication on the NHS reform programme Never Again. Read the rest of this entry »

When is a ‘GP led commissioning organisation’ GP led – and when is it not?

Filed Under (GP Commissioning, Health and Social Care Bill, Secretary of State) by Paul on 04-07-2012

One of the many choices that Andrew Lansley had to make when he became Secretary of State in 2010 was whether to develop the GP led commissioning of NHS services that he wanted within the current PCT structure or whether to introduce legislation to develop that policy. Famously he decided that he needed the biggest NHS Bill in history to enact his vision. In making this choice he obviously felt that developing existing legislation would not give GPs sufficient power. To really empower GPs as the leaders of the new commissioning framework he felt he needed completely new structures and legislation. Read the rest of this entry »

The intention of having practical clinicians commissioning care for their patients could be undermined by the process of authorising Clinical Commissioning Groups.

Filed Under (Clinical Commissioning Groups, GP Commissioning) by Paul on 03-07-2012

Yesterday I posed the suggestion that one of the main problems for NHS commissioning was the split between the practicality of doing the commissioning and the strategic level of planning. The standards of plans varied between ‘OK’ and ‘very good’ but for some PCTs the use of their powers and capacity of their commissioning to put those plans into effect was very minimal. Commissioning, in a number of places, simply meant handing out the money to the same providers as last year plus or minus a few percentage points. This continuation of past commissioning activity took place even where there was recognition – in the plans – that radical changes to health care were needed in the locality. Read the rest of this entry »

Planning and doing – one of the problematic schisms within NHS culture.

Filed Under (GP Commissioning, Primary Care Trusts) by Paul on 02-07-2012

Health care is essentially a very practical activity. It involves patients paying attention to the detail of looking after themselves and taking the drugs that they have been prescribed. It involves medical professionals carrying out diagnostic tests and working with patients that are experiencing pain and distress. The vast majority of NHS staff and patients experience the NHS as a very important set of practical activities. Read the rest of this entry »

Real integration needs tough, powerful integrators

Filed Under (Contracts, GP Commissioning, Integration) by Paul on 30-05-2012

Over the last few weeks I have been outlining the different mechanics of new elements of reform that will be necessary if commissioners are going to be able to transform health care for NHS patients. A few weeks ago I mentioned the importance of them buying effective packages of self care. Last week I outlined two different approaches to the way in which commissioners contract health care and today I want to outline some of the radical thinking that is taking place about how the provision of integrated care can be developed. Read the rest of this entry »

What are the necessary components for transformational commissioning of NHS patient services?

Filed Under (Contracts, GP Commissioning, Health Policy) by Paul on 27-05-2012

Over the years people have often asked me how all this reform fits together. I am afraid that the answer is that as I look at each individual aspect the conclusion I come to is that if you want transformational change in the NHS you have to do a number of new things at once.

Over the last few weeks I have been writing a series of blogs to try to outline the different mechanics that need to be at hand for NHS Commissioners to transform the health and health care that they commission. Read the rest of this entry »

Competitive dialogue – a better way of commissioning NHS services?

Filed Under (Competition, GP Commissioning) by Paul on 24-05-2012

Over my decades of working in the public sector, nearly all of my experiences of public sector service tendering have been a variation on some truly awful and nervous experiences. This was as true of my time as a public sector manager tendering for services as it is now – as a private sector person bidding to supply them. Nearly every part of every experience has been hedged around by the fear and anxiety of putting a foot wrong or saying a word out of place.  Read the rest of this entry »