Having had a chance since returning from a recent visit to the UK to reflect on the current changes around the commissioning role and function within the NHS in England, I’m left with a real sense of not being sure about where responsibility for strategic change in the NHS now lies.
Thanks to our colleagues at the Nuffield Trust, a group of us were treated to a number of visits around a wide range of innovative sites, and the chance to talk with clinicians, managers and policy writers.
One of the key questions we asked all of them was who did people look to for intellectual leadership and support when trying to drive change. The clear and consistent answer was there is no one individual or group. There was always some hesitancy as we asked the question, along with the usual list of national groups, but never was there any strong conviction around the answer.
It is clearly evident that some primary care trusts (PCTs) and some innovative practices have led and driven the debate, but as the current round of NHS reform highlights, both are vulnerable to swings in government policy. What seems to be left are national professional or union groups, both often far away from the action at the front line.
The challenges the NHS has as a system cannot be solved by politicians, hospital managers or policy-makers alone, but rather by a broader partnership with primary care. In New Zealand we have benefited from the organic development of primary care networks, from initial small groupings of GPs to the larger networks such as Midlands Health Network (MHN).
Key elements of the networks include their non-government status, they are private, usually not for profit and governed by those that own them – the primary care professionals in partnership with their patients. They have also established themselves beyond the reach of the policy swings of governments, and are now in fact leading and guiding much of the policy work.
MHN has a history based around quality improvement and the sustainability of the GP-patient relationship. While members continue to hold a broad spectrum of views about these issues, when compared to other regions of New Zealand, the MHN network has continually out-performed others. It has also enabled an alternative response to threats like corporatisation by foreign for-profits, and also the ability to pilot and trial a range of new approaches to both the business and clinical elements of primary care.
So from down under, I would suggest that primary care in the UK needs to group up, but not under instruction from the government, professional groups or the NHS, because to hold the debate you also need to own the way of getting there.
But don’t wait for an invite, I don’t think one will come…
John Macaskill-Smith is Chief Executive Officer of Midlands Health Network. Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors’ own.
Macaskill-Smith J (2011) ‘Primary Care Networks – one pathway to sustainable change’. Nuffield Trust comment, 4 August 2011. https://www.nuffieldtrust.org.uk/news-item/primary-care-networks-one-pathway-to-sustainable-change