12 May 2011
The Government Cannot Afford to Mess it up This Time
“The NHS is facing one of its most severe financial crises yet and, unless clinical commissioning and leadership remains truly at the heart of the health reforms, patients will bear the brunt of a system that will become incapable of delivering better health for better value.” This is the stark message from Dr Michael Dixon at the King's Fund/NHS Alliance conference for GP Commissioning Pathfinder leaders in London today.
"If you want clinical leadership, then you must allow clinical leaders to lead,” Dr Dixon will say. “If they are seen as puppets by their peers, then no-one will follow them. Clinical commissioning leaders have been out to bat three times already – as Locality Commissioners/Fundholders, leaders within Primary Care Groups and Practice Based Commissioners. Each time, clinical leadership has been strangled by the dead hand of centralism, bureaucracy and red tape. Don't let this happen again.”
He will add: “GP Consortia and GP consortia leaders have got a serious job to do, which is not helped by sniping from the sides or threats of destabilisation of many vested interests who are opposed to clinical leadership, primary care or decentralisation. We need to improve community services so that we can look after even the most dependent patients without them having to go to hospital. We must get serious about supporting self-care, personal health and developing community health - not just talking about it. Everyone agrees that the NHS needs to change and improve; dumbing down GP commissioning and straight jacketing its leaders is not the way forward.”
Dr Dixon will emphasise the need for primary care clinicians to be involved in equal footing with the secondary care colleagues in the debates around the Health and Social Care Bill, something which has failed to materialise so far and which the NHS Alliance is addressing by setting up its own listening exercise. The Alliance will gather the views of primary care clinicians and other health care professionals to continue the dialogue with Government and ensure that their views are heard.
He will reinforce the message that clinical leaders are prepared for the challenges ahead. “Contrary to some impressions given on high, clinical leaders know what they are doing. They know about governance processes and, throughout the country, consortia are making sure that they have good systems, which include primary care clinicians and specialists and which are truly ‘owned’ by local people.”
One example is Newcastle Bridges Commissioning Consortium, which has 16 practices serving the west and central area of Newcastle upon Tyne. The consortium has developed a governance structure that it believes reflects the fact that improvements in healthcare will only be achieved if clinicians, partner agencies and the wider community are fully engaged in decision making. It has a Consortium Board sitting above a Practice Board. The Consortium Board is the overall decision making body. It has an independent chair and a broader membership that includes three voluntary and community sector representatives, the Director of Public Health, a local authority representative and a nursing representative. The external members hold the majority of the votes on the Board.
The NHS Alliance will soon publish a paper – Making it Better: How GP-led consortia can unlock the full potential of the NHS – which shows examples of good practice and how clinical leaders up and down the country are making a real difference to their patients and communities.