The Changing NHS

I was running a half-day workshop last week for a newly formed PCT. About 50 people were in the room, mostly managers but a few GPs and local Councillors as well.

We spent the first couple of hours exploring what it meant to be a ‘Strategic Commissioner’ and how we needed to act differently than we had whilst working in the 3 previous PCT organisations.

All was going well. We had generated and prioritised a list of things to do ‘more of’ and ‘less of.

The top 5 ‘mores’ were:

1. Taking difficult decisions about priorities and shifting resources accordingly
2. Identifying and addressing unacceptable provider performance
3. Listening to clinicians (primary and secondary together wherever possible)
4. Incentivising providers to address specific service aspirations
5. Creating a strong public profile

The top 5 ‘lesses’ were:

1. Trying to implement all national guidance in good faith, regardless of local priorities and workload pressures
2. Acting as if we believe we are a junior partner in the local health economy
3. Spending time in face to face meetings with colleagues within the PCT
4. Complaining about acute provider behaviour
5. Writing reports

We then put some time aside to discuss these lists. I tried to get us started by asking what I thought was a straightforward question about the ‘more of’ list. I asked “Why do you think you weren't all that successful when operating in the previous PCTs?”

We didn’t get further than item one – taking difficult decisions about priorities etc - and the answer stopped me dead in my tracks. “We don’t feel we have the legitimacy to do this”.

If true, what is to be done?

How best to create a confident, authoritative culture where people are proud to help take difficult decisions?

Steve

www.stevepashley.co.uk