21 Dec, 11 | by BMJ Group
“We need to think about networks and define if they are commissioner or provider led.” I heard this said a few weeks ago. I also heard it said 3 years ago. I think the first time I heard it said was well over 10 years ago.
Creating a taxonomy for networks seems to be a labour for Sisyphus. Having been involved, more than once, in trying to define and clarify the role for networks I have begun to wonder if we are approaching this with the wrong question. Perhaps we should be wondering not what a network is but why do we need networks?
I have come to the conclusion that networks are needed to overcome the inadequacies of the system. The system is composed of organisations, tribes, and cultures which will rarely work together, of their own volition, to deliver a common objective—a common objective that must be defined by the patient’s requirements. Patient’s want, in fact I would suggest they expect, integrated care. They are not interested in primary, community, social, acute, or specialist services. What they want is to be diagnosed and to be supported in the best possible way to handle the consequences of that diagnosis.
Networks jump the barriers to making this happen; in fact they often need to tear them down. Networks bring people and resources together to work together to deliver a desired outcome. They are neither commissioner nor provider—they are patients’ networks. They have fluid functions moving across the system, sometimes involving many, sometimes just a few, in order to plan, do, check, and act, in order to drive up quality. Networks need to be plastic and shape themselves to the context: they may have elements of commissioning and provision. They need to be outcome focussed.
Networks also need to work across the strata in the system. Sometimes they just work at one level—horizontally. Peer benchmarking and review by networks has proved to be a powerful tool in driving up quality. Clinicians are intensely competitive. Having your peers look at comparative data and the way you work is a powerful force for improvement. CCGs are becoming (or have the potential to become) a membership network with a strong focus on quality. There are excellent examples at all levels of care where peer review and benchmarking has driven up quality.
Networks are also needed around natural patient pathways. These vertical networks need to cross the strata of primary, community, and specialist care, in localities. CCGs form the best possible building blocks for generating these networks so that patients receive safe, effective care with the best possible experience.
Organisations and systems move in the direction of the questions asked of them. We need to ask the right question about networks so we get the right answer—integrated care.
Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.