'The tectonic plates of healthcare are moving'

Doctors leader, Chaand Nagpaul, has a difficult path to tread in these times of radical change. Photograph: Manpreet Romana/AFP/Getty Images

Commenting on my open letter to the new chair of the GPC, Dr Chaand Nagpaul, David Cruise asks: "Could you clarify what it is you want. You call both for change and for continuity, for a return back in time and for a step into modernity." I confess that my call for a return to the old days of GPs taking responsibility for out of hours service might have sounded a shade retro. But I can assure you that the way I see general practice developing is quite radical, and there will be little room for GPs who want to carry on in the old way. I hope that Dr Nagpaul sees it the same way.

The tectonic plates of healthcare are moving, whether individual clinicians like it or not. Patients are getting older and more demanding and the younger ones are adopting ever unhealthier lifestyles. Hospitals will be reconfigured, A&E departments will be "consolidated" (ie closed). Drop-in centres will spring up; the private sector will come up with innovative ideas (mixed in with dollops of snake-oil). Social care and general practice will converge. GPs will have to learn new skills, like diplomacy and how to work with other people, to cope with it all. Their lives will be turned upside down, but they must stop harking back to a golden age where doctors were respected and patients knew their place. Dr Nagpaul has to show real leadership to point his unruly members forwards not backwards. Then there is the pressure of money (saving £30bn) and time. On one side, Dr Nagpaul will have to fight like a tiger to win the funding and resources needed to cope with the new pressures and new responsibilities. But on the other side, he will have to persuade doctors to see what they can do to use money more effectively. That will be an uphill struggle.

Forgive me if I give a trivial instance of waste that I experienced this week. A junior member of my GP practice asked me to come in to get a blood-pressure reading from the sister. I told him that I took my blood-pressure regularly at home. He pooh-poohed me, insisting that I come in, which I did obediently, to find that the sister's reading was the same as my home reading. To me, that was a waste of NHS resources, albeit a tiny one and a waste of my time. Not only that, he was going against the stated policy of the NHS to make patients more involved in their own care.

And that is another challenge for GPs. They have to get patients to involve themselves in their own treatments, and, hopefully, to persuade patients to avoid unhealthy lifestyles. And to understand their own patient records, which they should do by 2015, when the government wants patient records to become accessible to patients.

There is another challenge for Dr Nagpaul. Healthcare technology is moving fast, but GPs – and clinicians in general – have historically been obstructive. In these columns, I have often deplored the lack of email between doctor and patient, when the rest of the world uses email pervasively. When I see how dependent my GP is on my electronic patient record (EPR), I am shocked that out of hours practitioners are not given access to the GPs' records. This is a recipe for inappropriate treatment. And similarly, the opposition by clinicians on doctor/patient confidentiality grounds, to the summary care record, seemed to me to delay the adoption of electronic patient records by five or more years. Some senior doctors are currently trying to rubbish telehealth, without realising the benefits.

IT people get mad ideas from time to time, and need a restraining hand, and there are security problems with EPRs, but it is up to clinicians to engage with IT people to sort them out in pursuit of the greater good. Dr Nagpaul must somehow persuade GPs to engage positively with technology. He must get a new generation of young IT leads to help him. Everybody under the age of 35 is a digital native nowadays. And older GPs should get some training.

Dr Nagpaul, in a letter to GPs last week, wrote: "Now, more than ever, we must make the case for general practice to show how remarkably effective, and cost-effective, it is. I will aim to forge a renewed relationship with government, demonstrating how investing in general practice is key to managing escalating pressures in an NHS increasingly beleaguered by austerity measures." Indeed, but I hope he realises his task is bigger than that. It is to drag his members, kicking and screaming into the 21st century.

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View the original article here

'The tectonic plates of healthcare are moving'

Doctors leader, Chaand Nagpaul, has a difficult path to tread in these times of radical change. Photograph: Manpreet Romana/AFP/Getty Images

Commenting on my open letter to the new chair of the GPC, Dr Chaand Nagpaul, David Cruise asks: "Could you clarify what it is you want. You call both for change and for continuity, for a return back in time and for a step into modernity." I confess that my call for a return to the old days of GPs taking responsibility for out of hours service might have sounded a shade retro. But I can assure you that the way I see general practice developing is quite radical, and there will be little room for GPs who want to carry on in the old way. I hope that Dr Nagpaul sees it the same way.

The tectonic plates of healthcare are moving, whether individual clinicians like it or not. Patients are getting older and more demanding and the younger ones are adopting ever unhealthier lifestyles. Hospitals will be reconfigured, A&E departments will be "consolidated" (ie closed). Drop-in centres will spring up; the private sector will come up with innovative ideas (mixed in with dollops of snake-oil). Social care and general practice will converge. GPs will have to learn new skills, like diplomacy and how to work with other people, to cope with it all. Their lives will be turned upside down, but they must stop harking back to a golden age where doctors were respected and patients knew their place. Dr Nagpaul has to show real leadership to point his unruly members forwards not backwards. Then there is the pressure of money (saving £30bn) and time. On one side, Dr Nagpaul will have to fight like a tiger to win the funding and resources needed to cope with the new pressures and new responsibilities. But on the other side, he will have to persuade doctors to see what they can do to use money more effectively. That will be an uphill struggle.

Forgive me if I give a trivial instance of waste that I experienced this week. A junior member of my GP practice asked me to come in to get a blood-pressure reading from the sister. I told him that I took my blood-pressure regularly at home. He pooh-poohed me, insisting that I come in, which I did obediently, to find that the sister's reading was the same as my home reading. To me, that was a waste of NHS resources, albeit a tiny one and a waste of my time. Not only that, he was going against the stated policy of the NHS to make patients more involved in their own care.

And that is another challenge for GPs. They have to get patients to involve themselves in their own treatments, and, hopefully, to persuade patients to avoid unhealthy lifestyles. And to understand their own patient records, which they should do by 2015, when the government wants patient records to become accessible to patients.

There is another challenge for Dr Nagpaul. Healthcare technology is moving fast, but GPs – and clinicians in general – have historically been obstructive. In these columns, I have often deplored the lack of email between doctor and patient, when the rest of the world uses email pervasively. When I see how dependent my GP is on my electronic patient record (EPR), I am shocked that out of hours practitioners are not given access to the GPs' records. This is a recipe for inappropriate treatment. And similarly, the opposition by clinicians on doctor/patient confidentiality grounds, to the summary care record, seemed to me to delay the adoption of electronic patient records by five or more years. Some senior doctors are currently trying to rubbish telehealth, without realising the benefits.

IT people get mad ideas from time to time, and need a restraining hand, and there are security problems with EPRs, but it is up to clinicians to engage with IT people to sort them out in pursuit of the greater good. Dr Nagpaul must somehow persuade GPs to engage positively with technology. He must get a new generation of young IT leads to help him. Everybody under the age of 35 is a digital native nowadays. And older GPs should get some training.

Dr Nagpaul, in a letter to GPs last week, wrote: "Now, more than ever, we must make the case for general practice to show how remarkably effective, and cost-effective, it is. I will aim to forge a renewed relationship with government, demonstrating how investing in general practice is key to managing escalating pressures in an NHS increasingly beleaguered by austerity measures." Indeed, but I hope he realises his task is bigger than that. It is to drag his members, kicking and screaming into the 21st century.

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here

Discussion roundup: Moving from the NHS to the voluntary sector

The voluntary sector can provide a wealth of opportunities for those who have worked in the NHS. Photograph: Gary Roebuck/Alamy

Joop Tanis, independent consultant in innovation and entrepreneurship in health and social care: "There is a great opportunity for NHS clinicians and managers to organise themselves into co-operatives or social enterprises. This provides diversity of options for commissioners, and the opportunity to deliver the services you are passionate about in a way that is less constrained by the big NHS apparatus."

Neil Hogan, team leader and recruiter for Charity People: "Areas of opportunity that I've come across for healthcare professionals include policy, service delivery, leadership, campaigning, commissioning and bid tendering."

John Illingworth, policy manager at the Health Foundation: "We employ a wide range of people - project managers, research managers, communications, policy and corporate services professionals. In other words, roles and skills that you would find in a range of healthcare organisations."

James McHugh, responsible for research and policy at Skills - Third Sector: "In addition to the opportunity for NHS professionals to spin out into co-operative or mutual structures, there are also many opportunities for healthcare professionals to work in the existing third sector. Over half of the third sector's 800,000 paid employees work in health and social care. There are also around 37,000 organisations in the UK third sector which are active in this area. Much of this employment growth has been as a result of increased commissioning of such services from third sector organisations."

Neil Matthewman, chief executive of Community Integrated Care: "The voluntary sector, I have found, can offer greater freedom from bureaucracy and the opportunity to develop more influential relationships, raising the profile of our charity, influencing organisational development and directly improving the quality of the support that we are able to offer."

Steve Hindle, programme lead, Macmillan Cancer Support: "The ability to work for organisations such as Macmillan offers far greater scope and flexibility than many will have enjoyed in the NHS, as well as the satisfaction of making a difference, potentially at a national level."

Neil Matthewman: "In the third sector, we don't have this same level of restriction/support [as in the NHS]. So, organisational development can be lead by your own personal experience and skills. I have been able to influence the strategic direction of Community Integrated Care in a way that I couldn't directly do when working in the NHS and have been able to develop strong partnerships with other organisations as a result personal initiative. This has been refreshing and exciting."

Neil Matthewman: "As a financial consideration, leaving the NHS Pension Scheme is a potential challenge for some people. From my personal experience, this has been a barrier to some people joining the third-sector. I found that leaving my existing well-established professional networks was also slightly daunting."

Claire Westall, Macmillan Cancer Support: "Things move more quickly and decisions are made faster so I think that can be a significant culture shock sometimes. People may find they have a unique level of responsibility and ownership in the third sector, that didn't exist in the NHS, and this can be challenging at first."

James McHugh: "There are also a higher proportion of temporary roles in the third sector (around one in ten of all jobs) and the funding streams may seem more precarious in the third sector."

Joop Tanis: "I was surprised by the sense of empowerment and the ability to make decisions and actions quickly, but also the need to focus on delivering outcomes and milestones, which in my experience was much more 'immediate' than it felt in the public sector. However transferable to core skills - and they often are - the approach and culture is very different."

Neil Matthewman: "I was struck by the lack of external influencers when I moved to the third sector, other than organisations like the Charity Commission or CQC. In the NHS, we had milestones, world class commissioning etc. which heavily guided organisation development. This was a bit scary at first but liberating in many other ways, as it relies on you, as an individual leader, to take the organisation forward, based upon your knowledge and experience."

Joop Tanis: "While my managerial responsibility (budget, headcount etc) was much greater in the NHS, my ability to do things and have an impact was greater outside."

Steve Hindle: "I think a further difference for people moving from the NHS may be the way that the voluntary sector can work with the media to highlight awareness of issues and spread innovative solutions."

John Illingworth: "I think people moving from the NHS feel a certain degree of liberation, from daily fire-fighting to championing good causes in order to deliver real improvements for people."

Steve Hindle: "What I've found during my time at Macmillan is that colleagues who have recently left the NHS are invaluable for their expertise, often based on decades of experience, and their understanding of the way current issues are impacting on outcomes."

James McHugh: "From a third sector perspective some of the skills/expertise around commissioning, service design, people management, governance, monitoring and evaluation, and partnership work are immensely valuable."

Joop Tanis: "Apart from the obvious clinical or service skills, [healthcare professionals] have an in-depth knowledge of the current services, standards and decision making processes. They often understand commissioning."

Steve Hindle: "There are a range of skills that can transfer into the voluntary sector - speaking for my survivorship team, I have people with combinations of clinical expertise, service development and service redesign expertise, commissioning skills, policy work, project/programme management, user involvement and negotiating and influencing skills."

Neil Matthewman: "At a senior level you need an ability to lead people strategically and to set the direction for the organisation. The ability to hold people to account is also important. From a personal perspective, understanding commerciality is also particularly important."

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here