Martin McShane: Shared Care

Martin McShaneOver the last year NHS Lincolnshire has instituted a clinical cabinet, a meeting where professionals from across the health and social care system meet to grapple with an important theme and give commissioners (PCT and Clusters) insight, advice, and direction.

This month’s theme was shared care.  From inception, our professional executive chair insisted that the cabinet should start with a patient story – told by a patient. If only all our meetings started the same way. Nobody remembers a 124 page document. We all remember stories.

So let me tell you the story I heard.  Bill* is not old; he is working age. Early this century he developed odd symptoms which puzzled a lot of professionals, until an open lung biopsy revealed that he had sarcoidosis. His GP, somehow, had managed to find a student statistician to analyse his notes. Since 2003 Bill has been to 8 hospitals, 12 Departments, seen 62 specialists (never seeing the same consultant twice) and has had to travel 11,500 miles. As Bill put it, dryly and without rancour, “Many of those journeys seemed utterly pointless once I got there, what needed to be done could have been done over the phone or by my GP”. There are 6 GPs in his practice. He sticks to two, mainly. Since 2002 he has had 195 appointments, 138 blood tests and 843 prescriptions. By the way, it is a rural practice, so that has meant another 1,150 miles of travel.

He has needed oxygen therapy, methotrexate, influximib (after application to the individual funding review panel), cyclosporin, anti TNF and mycophenyolate. The treatment has worked, although he has now also developed hypertension, type II diabetes, had depression, and a fatty liver.

The three hospitals won’t share his medical records and, as ever, communication both across the system and with Bill has been found wanting.

This week I have sat down with consultants who tell me they need more resources. I have heard GPs saying we need to invest more in Primary Care. I have also seen data which tells me that over 40% of the costs of patient care for clusters of practices are driven by emergency admissions, which are less than 10% of the activity. Many of those admissions will be due to failures to co-ordinate and share care well for people like Bill, people with polypathology.

Cases like Bill’s are consuming resources in a way which is wasteful. No one takes responsibility for co-ordinating care in an integrated way. I heard Bill’s story before I read the McKinsey analysis of what needs to happen to make best use of the resources given to the NHS. Bill’s story made sense of that 124 page document. Even Bill felt 30% of his appointments were a complete waste of his and NHS time.

We are at a time of change, a time of opportunity. We need to use stories like Bill’s to focus on what is important and stop squandering precious public money.

* Patient consent obtained.

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.