Back in May 2010 the professional executive committee and NHS Lincolnshire board agreed to delegate the management of the minor surgery local enhanced service to the practice based commissioning (PBC) Groups.  A lot of discussion and analysis had taken place prior to this decision. Practices had said that the historical budget was insufficient to meet demand and that without  investment GPs would be forced to make a referrals to hospital based services which would cost more. Concerns were raised about managing demand, the appropriateness of the surgery and whether increasing investment in primary care services would have any real impact on referrals into secondary care. Out of the debate emerged the “experiment” which the Board sanctioned. more…

As part of the development of our Clinical Commissioning Groups (CCGs) the seven GP CCG chairs now have a place at the NHS Lincolnshire Board meetings.  The agenda was not particularly unusual. We were required to approve the Equality and Diversity Strategy. We had a couple of papers dealing with our legacy document and the transition planning process. There were the important performance and financial monitoring reports. It is the time of year when we present the annual governance, audit committee and annual reports and summary financial statements. We had a formal letter from the Strategic Health Authority (SHA) to note and an associated action plan (completed – in case they read this!). We reviewed the Board assurance framework, the risk management annual report, and the business continuity management update. more…

The government has set out its stall in detail on the changes it will make to the Health and Social Care Bill. Many of the BMA’s concerns were addressed by the NHS Future Forum and the government’s response. This includes restoring health secretary’s responsibilities, modifying Monitor’s duty to promote competition, and the need for clinicians other than GPs to be involved in commissioning. But, will it be enough to save the NHS? more…

The pause ended in dramatic fashion last week with the publication of the NHS Future Forum’s recommendations. 

Most interesting was the orthopaedic surgeon at Guys Hospital who confronted the prime minster and deputy prime minister in a rage because the camera crew were not suitably dressed for a hospital. 

It hit home on all sorts of levels.  more…

I’ve stayed out of the NHS debate. These days I spend lots of time in countries like Bangladesh, Kenya, and Guatemala, and viewed from those countries - where health workers and essential drugs are often missing – you wonder why the fuss over the NHS. Everybody has a doctor, primary care is strong, and access to specialist care is easy. What’s the problem? more…

The changes the government is proposing in response to the NHS Future Forum might satisfy most of the people for some of the time but their implementation immediately struck me as posing a number of problems. Where the changes stick to principles, for instance around the NHS constitution, the role of the secretary of state, Monitor’s core duties, then they seem sensible and address many of the concerns raised as a result of the proposed legislation. more…

David Cameron’s speech on NHS reform this week should have marked a substantial victory for doctors’ leaders. In recent months they have been even more outspoken than usual in their opposition to whatever it is the government’s saying this week and David Cameron let them know he was all ears. “I’ve heard the passion of our… doctors,” “I’ve heard doctors tell me,” “I’ve heard our hospital doctors,” “Doctors said we should,” “It’s what doctors and nurses want.” “How high should I jump?” Only one of those may be fictional. more…

Suppose a pathologist was to say, “Because I am not a GP I do not belong here.” Or a GP was to say, “Because I am not a cardio-thoracic surgeon I do not belong here.” No, (paraphrasing St Paul) we are all parts of one body of medical enterprise, and the patients need different doctors at different times – sometimes more specialised and sometimes more general. more…

I read the King’s fund paper on management in the NHS. It should be read widely. Some politicians and professionals understand that successful organisations have good management. Some even understand that bureaucracy is a product of a set of rules. A bureaucrat can’t be a bureaucrat without those rules. The rules I have to work to frequently irritate and frustrate me. I find the rules on procurement byzantine, lengthy to negotiate, and so mechanistic and transactional that using them to deliver transformation, which requires flexibility, adaptability and nimbleness, is counter cultural to the whole process. It’s a bureaucracy which we have to try and manage. We are given it. We don’t create it. more…

Suddenly Health Secretary Andrew Lansley’s proposals to “reform” the NHS look safe. For more than nine months, since the publication of Liberating the NHS last July, doctors, nurses, think tanks, and academics have been begging Lansley to re-think his ideas. By the start of the “pause” in April, it looked as though the government would take some of these criticisms on board and make concessions. more…