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.

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Two practical ways for GPs to take on the newly empowered NHS centre

Filed Under (GP Commissioning, GPs, Reform of the NHS, Secretary of State) by Paul on 23-03-2011

This week I am exploring the way in which the alternate power sources of the Government’s NHS reform programme have been set up to clash and conflict.

Yesterday I discussed the way in which the CEO of the NHS Commissioning Board is planning to centralise power under his control over the next two years before apparently decentralising it to GPs.

The current Secretary of State has correctly labelled GP Commissioners as “enthusiastic” as they try to find a way to develop their Commissioning Consortia over the next few months.

Given these two forces, it is inevitable that there will be some form of clash between the newly empowered centre of the NHS under David Nicholson, and these decentralised power bases of GP Commissioning Consortia.

The whole of Government policy for NHS reform hinges on the outcome of these interactions. At the moment the Government is proud of its over 140 pathfinder GP Commissioning Consortia. They are encouraging them to get on with new forms of commissioning patient pathways as a part of their activity. However if these pathfinders start to come across the heavy stamping boot of NHS centralisation smashing down upon their attempts at innovation, they are likely to step back.

And GPs are different from predecessor PCT CEOs. The latter could experience belt tightening from a centralising NHS as being just an inevitable part of the job. They had to put up with if they wanted a career in the NHS. The DH shouted at the SHA who in turn shouted at the PCT CEO. Since, as an NHS manager, your career had nowhere else to go and this was, after all the culture of which you were a part, you just accepted it.

None of this is true for GPs. They really don’t need to do this. They are only engaging in the process of getting into commissioning because they want to. They already have another job. Indeed it is a job they love. If the conditions they have been promised under which to develop commissioning do not materialise, they can walk away and go back to being GPs. If instead of liberation they are kicked around all over the NHS by the Commissioning Board and its clusters, then they can, and will, walk away.

It is then that Government plans fall apart. If the 140 pathfinders become 100 by the early summer, and word gets out that the NHS will not allow GP Commissioning consortia to flourish, numbers will dwindle.

I am not sure the current Secretary of State realises this. He is right to see these GPs as enthusiastic, but if that enthusiasm wanes and GP start to walk away his policy collapses. Therefore NHS reform and his entire future are in the hands of this interaction between GPs and the centralising NHS Commissioning Board.

If I were him this would worry me. Since I am pretty sure David Nicholson will know that he can scare GPs away from the whole policy if he behaves a bit shouty.

But before that actually happens I have been giving GPs around the country two pieces of advice on how to take on the over-centralisation of the DH.

The first reflects the fact that the NHS is not only a centralised organisation to Whitehall, but it is also an organisation for which Parliament feels responsible. So if you are a GP commissioner who has not been allowed to lead commissioning my advice would be to find a local MP and arrange to see them every month.

If they are a Government MP, then through the White Paper they have made an offer to GPs to empower them as a part of a commissioning organisation. If the CEO of the NHS Commissioning Board has decided to disempower them because he wants to centralise power, then the GP has a right to appeal to their MP. It would seem worthwhile for the GPs to ask the MP to have a conversation with the current Secretary of State.

I have often said on this blog that the current Secretary of State is just not very good at politics. But even he would have to recognise that his colleagues were supporting their GP constituents. If a number of MPs consistently defend their GPs the Secretary of State will have to tackle David Nicholson’s avowed policy of centralisation.

And what if the GP has a Labour MP? They too would have an interest in picking up this issue. They would recognise – as is the case – that there was a contradiction between what the Government had promised – liberation – and what the Government was delivering – centralisation.

So even Labour MPs have a reason for picking this up.

My second piece of advice to those GPs who want to develop local commissioning organisations would be to go along and see their local authority Chief Executive. Local authority CEOs recognise that their health and well being boards will not mean anything unless they have some local power.  The CEOs recognise that if their local GP Commissioning Consortia were told what to do by the NHS Commissioning Board, then their locality will lose out.

Local Authority CEOs have a lot of experience of defending locality against Whitehall. Their advice on tactics and strategy for GP organisations would be invaluable.

So as we used to say in the late 1960s Don’t face the man on your own. GPs need to find allies to help defend their locality against the centre. For the moment their best allies will be MPs and local government chief executives.

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