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 »

News from the Confed….

Filed Under (GP Commissioning, GPs, Reform of the NHS) by Paul on 23-06-2010

…is not encouraging. They meet in Liverpool being confronted by a radical new Secretary of State who wants to make radical changes to the way in which the NHS organises itself. The Confed collectively, and many of the individuals within it, who run the nation’s NHS organisations, believe that they have most of the knowledge needed to maintain and improve the NHS. They therefore confront most external change agents – and a new Secretary of State is an external change agent – with a sort of sophisticated world-weariness.

They confront the outsider with the belief that, really, if they had spent more time in the system, if they had listened to them before they came up with their plans, then they would be much more sophisticated, and produce better plans much more in keeping with the way the NHS has been and is being run. Yes, in their world view that’s true but it sort of misses the point.

A radical Secretary of State has brought ideas from outside of the status quo. By definition they are “outside” and have been created to have an impact from “outside”. The “inside” finds that at best very difficult, and at worst bewildering.

And that is what GP commissioning is for the Confed. They label this as another “restructuring”, as another example of moving the state organisations around to be bigger, smaller or just “different” and they quite rightly say that has been tried several times before.

But they are wrong to see this as just another restructuring exercise. It isn’t. Whilst this is still placing commissioning in the hands of the NHS, GPs are very different non-state hands. These are GP, clinician, small business hands. They will have very different drivers from the state hands that have been running PCGs PCTs etc etc.

And the real problem for the Confed is that these future commissioners are not just outside the Confed but will be very developed as very different organisational forms. Up and down England PCTs are trying to get their head around the change and some of them will try and turn this into another internal reorganisations – a pain but really what has gone on before.

It isn’t.

GPs are not, and will not, be state organisations. They are not a part of the state infrastructure of the NHS to reorganise. Bevan failed to nationalise and Lansley will not do that. The SHAs are trying to move armies of GPs about into the correct regimental strength so that they will be the right size for the SHA. Those SHAs that are trying to find the right organisational size for their GPs to fit that shape are missing the point and losing the plot. The GPs will do this outside the state. It is their responsibility to find their way, their size, and their organisation.

We and others can offer help. But they will complete this themselves. The more PCTs and SHAs try and move GPs around as if they are pieces on a board, the less influence they will have.

My point to the Confed is that this is indeed much more radical than they have seen before. It can’t both be that AND yet another reconfiguration.


4 Responses to “News from the Confed….”

  1. Hi

    I think the confederation does recognise that this isn’t just another restructuring and agrees with the point you make.

    It’s certainly the point we’ll be making thoughout the conference.

    This is what Nigel said in his speech yesterday afternoon:

    “I think – based on our discussions with the Secretary of State and other officials – that the ideas you will hear about over the next few days and in the upcoming White Paper are an attempt to make a fundamental shift in how power and accountability works in the NHS. If it succeeds, this is much more radical that many have realised and will alter the landscape profoundly.”

    Hope you find the rest of the conference more encouraging.

  2. I am sure Niall is right and its my fault for confusing the capital C Confed – that is the organisation that runs the conference – and the small c confed that is the membership. I agree that capital C especially Nigel Edwards understands that this change is different.But most existing NHS organsiations because of their learnt experience treat this as another internal NHS reorganisation where bits need to be moved around.

    With any luck more people will hear Nigel and pay attention to his message that they need to unlearn the behaviour of the past.

  3. This is a very important point indeed.

    I think there will be two ways in which patients will have a set of rights to ensure that their needs are taken into consideration. The most important, and consistent with the whole thrust of the reforms, will be the right of the patient to choose their GP commissioner. I live in Southwark and at the moment along with all other NHS patients I have no choice of my commissioner. It is NHS Southwark the PCT. They commission health care for the population and if I look at the way in which another commissioner commissions health care – say NHS Lambeth – I cant say that I would rather have them do the commissioning for my health care. If I can choose my GP commissioner then they would make a case out to for specific better commissioning around being better at, say, commissioning the health care needs of slightly overweight men over the age of 60. Choice of commissioner is essential. That is why if the size of the consortia is so big that there is no choice, then one of the major parts of progress of the new architecture will fail. Choice of GP commissioner for the state-insured patient will be a big step forward.
    Second the coalition plans have a set of duties laid upon a PCT with elected representatives on them – that will ensure all localities have a ‘patient voice’. I suspect as the Bill passes through Parliament this will become the public health department of the local authority with a Medical Officer of Health in charge. This would provide a strong publicly accountable motive for those patients who felt the GP commissioner had let them down. The Oversight and Scrutiny Panel for the local authority would have hearings looking at what their GP commissioners are doing with their public money.

  4. I have too being bleating about choice of commissioner for a long time – and some of that was in the Department of Health. But afraid that I was in a minion role – and who could think that an – ‘equality and diversity’ chick could have a couple of brain cells and think policy. I was at the confederation – and came away thinking of the opportunities the changes offers. Certainly, if I were a large provider, I would be considering my community presence and of the restraint of trade acts if they were not allowed to pitch for joint ventures with some GP consortia.

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