Martin McShane: Enthusiasm, cynicism, pragmatism and Pathfinders.

Martin McShaneIn Lincolnshire, we had 3 Pathfinder consortia announced in the second wave. This is good news. At least, we think it is. We are, however, not sure what being a “Pathfinder” means.  It would appear to mean that GPs are enthusiastic about the reforms and taking up the challenge. Is that true?

I was at a meeting recently where there were a number of GPs from around the country and I heard them talking about Pathfinder status. I was struck by hearing them say; “We thought we ought to apply for Pathfinder because we didn’t want to miss out.” I understood why they were saying that as I reflected on my own experience as a GP and as an executive working for the NHS over the last 20 years.

I entered General Practice in 1990 and experienced fundholding at first hand. In fact, it undoubtedly kicked off my interest in health service management, as I was given the job of fundholding lead for the practice. The first wave fundholding practices benefited from being the early adopters. The benefits to the practice of switching to fundholding, however, diminished with each successive wave. The same sort of thing happened with the option of switching to a PMS (personal medical services) contract for practices. Early adopters had easier access to increased funding than the later entrants.  Then there were PCGs in 1999. Remember them? They lasted a couple of years and were replaced by PCTs. A few years later they were replaced by bigger PCTs in most areas. Clinicians and staff involved in those organisations have learnt that the easiest way to cope with the changes is to embrace them and get on with it. Resistance or reluctance is futile and means you miss out on any potential benefits that might come your way.  It is a learnt behaviour, as a consequence of two decades of ceaseless top-down reorganisation.

Of the seven nascent consortia in Lincolnshire, six applied for Pathfinder status. None were granted in the first wave which was announced in December. If this had been fundholding they would have had to wait a year to get a chance to go in the second wave. The first wave of fundholding demonstrated some of the unintended consequences of those reforms.  The excesses and risks were mitigated and managed with each successive annual wave. The second wave of Pathfinders was announced in January, which is when our three consortia were accepted. So what had changed between December and January? What learning could the second wave learn from the first wave? What is the point in being a Pathfinder if, as seems likely, by the third wave the majority of GP practices are going to be Pathfinders?

Let’s not be cynical about this but let’s be honest and realistic.  The reason so many GP practices in their nascent consortia have applied for Pathfinder status is not because of wild enthusiasm for the reforms. The reason they have applied is pragmatism.

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.