CLINICAL LEADERSHIP
Seeing clinicians as the answer not the problem A
Dr Michael Dixon is chair of the NHS Alliance
n intelligent
Martian would have been bewildered by the way we used
to run the NHS. Government made policy, managers carried it out, while clinicians - largely separated from it all - continue to spend NHS money disconnected from all of them.
The state of affairs came about because senior managers have tried to run the NHS, largely independent of clinicians. Meanwhile, those same clinicians, alienated and disempowered, had decided that productivity and budget deficits were none of their business.
The previous belief in Whitehall that GPs, community nurses and other frontline clinicians could be run by “command and control” through SHAs and PCTs was sadly misguided. Yet without proper clinical buy- in and emancipated clinical leadership, any attempts to tackle an NHS deficit are always bound to end in tears.
The NHS Leadership Council was a good example of what was wrong with the old order. Its membership didn’t include any primary care frontline clinician. It was, in some ways, the last gasp of an order that was rapidly disappearing up its own proverbial behind.
the approaching
financial holocaust can only be faced if clinicians can be persuaded to get their backs behind current reforms
Jul/Aug 10
So given the logic that those, who are largely responsible for spending decisions (such as referrals, prescriptions and diagnostic tests) need to be involved in any drive to improve productivity and reduce deficits – how do we achieve this?
The answer is that it can be done quite simply by implementing much of the rhetoric of our new
coalition government. That is decentralising, enabling frontline clinicians and encouraging a co- leadership model with clinicians and managers leading rather than the previous dysfunctional system of senior managers telling clinicians what to do and the latter walking away.
Visible frontline clinical leadership at all levels of the NHS would be a good start including the Department of Health (where primary care clinical leadership currently rests in the hands of just one person!).
As PCTs hand their commissioning role to GP consortia, we need to create and inspire a new generation of local frontline clinicians. Within consortia, clinicians will now need to be empowered and enabled to make decisions on financial prioritisation, service redesign and local health.
Those behind the times are still talking about “clinician engagement”. It is now too late for “engagement” as only full ownership and leadership of clinicians will suffice if our current government is to achieve its aims.
“You can take a horse to water but you cannot make it drink”. To succeed, the new coalition government needs to inspire and enable NHS clinicians to deliver its health reforms.
Managers will talk of ‘incentives’ but, for clinicians, full ownership of NHS solutions requires far more than the odd incentive or target. In this respect, the government seems to be ahead of some senior NHS managers in recognising the practicalities of trying to direct the behaviour of clinicians such as GPs,
pharmacists and dentists, who are independent contractors and therefore (in theory at least) not part of a line management hierarchy in the first place.
It is a deep irony but also a deep truth that the approaching financial holocaust can only be faced if clinicians can be persuaded to get their backs behind current reforms.
Just as Churchill was so necessary in the dark days of WWII, so today are clinicians if the NHS is to prove sustainable. Because as a soup kitchen for patients, who regard themselves as consumers or for clinicians driven by personal profit, the NHS is no longer sustainable. As an enterprise where each wants and has a role, it may prove to be one of the few health systems in the world that can be.
All of this depends upon government and its clinicians recognising their mutual importance and creating a coalition of aims and plans. In short, it means moving away from recent years of alienation and mistrust between clinicians and the government. It will require some change and some give and take on both sides. The managers in the middle will need to learn to share power and responsibility and we might then create an NHS where co- production and co-ownership became a reality.
There is little doubt now that the coalition government means to make this offer to NHS clinicians. The bigger question now, perhaps, is whether those same clinicians will have the courage to face the difficult decisions, responsibilities and sacrifices that full empowerment entails.
nhe 31
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100