Faceless Bureaucrat: How bizarre to be in this situation. Personally I agree that bureaucracy in the NHS has burgeoned out of control and has gone beyond the point of adding value. I also agree that clinicians, particularly GPs, should be driving the decisions about use of health care resources in their area. These are the key points the Coalition Government makes and hence their decision to make nearly 21,000 NHS managers redundant and it looks like I'll be one of them if I don't sort something out by April.
They are estimating a redundancy bill of £1billion, it's a high price to pay for this strategy, let's hope it's worth it in the terms of the radical changes needed.
I can see why they feel it's necessary. Many of us have been institutionalised as NHS managers, we can be wedded to complex and lengthy decision making processes, we can be prone to avoiding risk and we can give more weight to following orders from on high than working with local clinicians and communities to determining what is needed and putting that first. But to be honest we are public servants, following the orders of a democratically elected Government. The last Government, despite what they said, made it crystal clear they wanted us to look upwards rather than outwards and as one of their national advisers said to me last year "bureaucracy is in their DNA" so it became part of ours.
Give us a new set of masters and we follow their orders instead. In a democracy it's what the tax payer would want from public servants, what's the alternative? Rebellion and chaos...
So here we are now, diligently obeying the next set of democratically determined orders and helping the new GP commissioning consortia to get up and running whilst, in an orderly fashion, sacking our colleagues and ourselves. We are the turkeys voting for Christmas and I'm one of them, right up to the point where I become a bad assed trader.
I recently commented on the BBC website that I support the changes being proposed even though I am at risk of being made redundant and ended up being interviewed on Drive Time BBC London to share my thoughts with the world. I'll tell anyone who cares to listen...
It doesn't mean I'm happy with the way things are turning out. I was completely sold on the prospect of GPs determining the size and shape of their commissioning consortia but sadly many of them are plumping for massive organisations that are looking uncannily like the Primary Care Trusts they are supposedly replacing. How will this be different? Come on guys - you're not managers - do this differently! This is the whole point. It's what we're sacrificing our careers for.
The strength of general practice and GPs is that they understand their patients, their families and their local communities at a very deep level. They are small enough to be responsive and fleet of foot in decision making and implementing change. They understand the clinical impact of change, they appreciate the relevant importance of one treatment regime against another. They see the inefficiencies day in day out and as master problem solvers they often see the solution, where things need to change to help the patient get more quickly to the help they need.
They are at the heart of the NHS front line, the centre of the network of local support, the co-ordinator and advocate for the patient and this is what needs to be brought forward as the driving force of commissioning in this brave new world.
But they're scared. They see the £20bn headline for savings the NHS needs to make over the next 3 years and they're worried that if they don't perform that their personal income will be affected or they'll be thrown out of general practice. They figure there's safety in numbers so they cling together, pooling resources as they see it to be more economically efficient. But is it? If it was then why didn't it work last time round? Are big organisations really more financially efficient? From my view they tend to be big lumbering, one size fits all, lowest common denominator driven, bureaucratically heavy, anti innovation, demoralising and disempowering lumps of anti matter.
Why don't the GPs keep the power house local and club together at a higher level to bulk buy as they see fit? Drive it from the bottom up rather than giving up their power to the higher authority?
Yes they would have nowhere to hide in terms of responsibility and accountability but actually they still will with the bigger set up, the difference is that unless they're a mover or shaker in the new arrangement their power and influence is massively diluted. A price worth paying to be part of a big herd?
Maybe when the dust settles that is what they'll do, set up some local decision making processes to drive their organisations, I hope so. If I'm paying for this change with my job I'd really like to see some courage and innovation being put into play here. I've worked with GPs supporting them to commission services for the last 10 years, I still believe they can do it, but they need to be clear about their strengths and weaknesses, take their courage in both hands and go for it.
Here I am, the supposedly risk averse faceless bureaucrat, forging my alternative career in the notoriously high risk Forex trading to help bring this new world into play, I'd really like to see the new NHS leaders accepting some of the risks inherent with their new powers...
They are estimating a redundancy bill of £1billion, it's a high price to pay for this strategy, let's hope it's worth it in the terms of the radical changes needed.
I can see why they feel it's necessary. Many of us have been institutionalised as NHS managers, we can be wedded to complex and lengthy decision making processes, we can be prone to avoiding risk and we can give more weight to following orders from on high than working with local clinicians and communities to determining what is needed and putting that first. But to be honest we are public servants, following the orders of a democratically elected Government. The last Government, despite what they said, made it crystal clear they wanted us to look upwards rather than outwards and as one of their national advisers said to me last year "bureaucracy is in their DNA" so it became part of ours.
Give us a new set of masters and we follow their orders instead. In a democracy it's what the tax payer would want from public servants, what's the alternative? Rebellion and chaos...
So here we are now, diligently obeying the next set of democratically determined orders and helping the new GP commissioning consortia to get up and running whilst, in an orderly fashion, sacking our colleagues and ourselves. We are the turkeys voting for Christmas and I'm one of them, right up to the point where I become a bad assed trader.
I recently commented on the BBC website that I support the changes being proposed even though I am at risk of being made redundant and ended up being interviewed on Drive Time BBC London to share my thoughts with the world. I'll tell anyone who cares to listen...
It doesn't mean I'm happy with the way things are turning out. I was completely sold on the prospect of GPs determining the size and shape of their commissioning consortia but sadly many of them are plumping for massive organisations that are looking uncannily like the Primary Care Trusts they are supposedly replacing. How will this be different? Come on guys - you're not managers - do this differently! This is the whole point. It's what we're sacrificing our careers for.
The strength of general practice and GPs is that they understand their patients, their families and their local communities at a very deep level. They are small enough to be responsive and fleet of foot in decision making and implementing change. They understand the clinical impact of change, they appreciate the relevant importance of one treatment regime against another. They see the inefficiencies day in day out and as master problem solvers they often see the solution, where things need to change to help the patient get more quickly to the help they need.
They are at the heart of the NHS front line, the centre of the network of local support, the co-ordinator and advocate for the patient and this is what needs to be brought forward as the driving force of commissioning in this brave new world.
But they're scared. They see the £20bn headline for savings the NHS needs to make over the next 3 years and they're worried that if they don't perform that their personal income will be affected or they'll be thrown out of general practice. They figure there's safety in numbers so they cling together, pooling resources as they see it to be more economically efficient. But is it? If it was then why didn't it work last time round? Are big organisations really more financially efficient? From my view they tend to be big lumbering, one size fits all, lowest common denominator driven, bureaucratically heavy, anti innovation, demoralising and disempowering lumps of anti matter.
Why don't the GPs keep the power house local and club together at a higher level to bulk buy as they see fit? Drive it from the bottom up rather than giving up their power to the higher authority?
Yes they would have nowhere to hide in terms of responsibility and accountability but actually they still will with the bigger set up, the difference is that unless they're a mover or shaker in the new arrangement their power and influence is massively diluted. A price worth paying to be part of a big herd?
Maybe when the dust settles that is what they'll do, set up some local decision making processes to drive their organisations, I hope so. If I'm paying for this change with my job I'd really like to see some courage and innovation being put into play here. I've worked with GPs supporting them to commission services for the last 10 years, I still believe they can do it, but they need to be clear about their strengths and weaknesses, take their courage in both hands and go for it.
Here I am, the supposedly risk averse faceless bureaucrat, forging my alternative career in the notoriously high risk Forex trading to help bring this new world into play, I'd really like to see the new NHS leaders accepting some of the risks inherent with their new powers...
Question: If GPs are now in total control and are setting up contracts with various organisations to provide different services, how will they be able to react quickly and change their services when needed?
ReplyDeleteSurely if a practice has to drop one service in order to pick up another (depending on budget), won't that require a round of research, reviews, meetings, spec documents and contract negotiations? I have sat in enough of these meetings to know that these sorts of projects rarely run quickly or smoothly!
Although I agree that more power should be given at a local level, I want my GP to be just that, a GP! Not a businessman!
Aren't you wandering off topic a little?
ReplyDeleteOther than that, you are right, all that will happen is that the names and job titles will be changed, and the experienced managers will be made redundant and replaced by amateurs.
We are all doomed
Thanks for the interesting comments guys and I agree with you both. Nelly, there are downsides as you rightly point out but the role of GPs will be to provide the leadership, priorities and general steer. Some of them may get involved in redesigning specific services in which they have a clinical interest but they will do that on behalf of others so they won't all have to do it.
ReplyDeleteOh, and in terms of reacting quickly, there's been no danger of that for the last few years so it can't get any worse.
Poobah, I agree with everything up to the doomed bit. Ever the optimist, me.