Sunday, March 31, 2013

Plan B

Back from a lovely holiday...and back to work tomorrow. April 1st- Easter Monday- and as per numerous blogs, tweets etc...the end of the NHS as we know it. 

New regulations come into operation and beyond the structural change, as per a lot of pretty senior and important people, what is changing, is the fundamental nature of the NHS..a possible move towards privatisation. And over the last year or so, twitter has been  source of education,listening and reading about opinions from folks who staunchly believe in the ethos of the NHS. Having worked in a country like India, for me personally, it has been nothing but astonishment at what the NHS delivers, let alone simple belief! 
Among the many figures of Clive Peedell,Rob Cheeseman, David Nicholl,Margaret McCartney, Roy Lilley, Jonathan Tomlinson exhorting us to be aware of what we are inexorably moving towards, a single voice stood out simply for its clarity. Clare Gerada. She has been everywhere, trying everything she possibly could to stem the tide. NewsNight, BBC Question Time...you name it, she's there...fighting the battle.And you have to just stand back and admire that level of  indefatigability. But in spite of everything, the juggernaut has rolled on. Hate to use the clich├ęd term " we are where we are" but what now? If everything is overturned again in 2 years and competition scrapped, maybe we could revise and take fresh guard- but now that the changes are  pretty much in law, what of us healthcare professionals who stay in the NHS from 1st April onwards? Actions such as "early retirement"  isn't an option, "doing something else" isn't one either...so what now for the young brigade? Do we have a plan B?

So the new age is here. The NHS,perhaps open to competition, open to the private sector, open to the world of profit...and are we as doctors ready to adapt accordingly? Do we have the energy, time and will to understand cost, activity, tariff, income? Can we talk in pure financial sense,show to the powers that be, that we do "justify our salary"? Like a silver lining to the threatening cloud, would this open up the door to stop looking at the managers as one from the dark side- and understand how we could work together to "justify" our services? To some, understandably, having to "justify" ourselves is an anathema but the hard nosed business world unfortunately won't take the argument " we work really hard".

Can we introduce another dimension where beyond the patient feedback, it will also be genuinely about outcomes, transparency...so when services go up for tender, as the clinician concerned, you will be able to assure your Trust that with the data, feedback etc you have, this bid will be won, led by clinicians- working hand in hand with managers? Would we as hospital clinicians forget the divide and sit down with our primary care colleagues to understand what running a business means? Would we invite the finance director for a coffee to explain which bits as a clinician we could impact on? Would we share a drink with the contracts team and make sure nothing is signed without full clinical involvement..try to understand the language of new to follow up ratios, demand management they speak in? 

So many questions...but surely its always good to have a plan B? Maybe its me, but I have never approached a project without 3 options- a primary one- and 2 fall back options. All I can say is that all those folks I have just mentioned would be delighted to meet the clinician who is willing to input their views...they are trying to understand our language too.
Let me put this question to you...if the trust signs a contract to a new to follow up ratio or agrees to "number of patients to be seen" without clinical involvement- as the clinician had "better things to do", then come August, when the Trust is due to breach the agreed numbers, guess who the pressure comes back to? So far it has been OK  as next year, whatever be the outcome of the contract, the activity would still come back to the same provider, i.e. your Trust. Now the games changing...what happens if another provider walks away with the contract because they "promised to deliver better" or had a slicker presentation? Yep, YOU are now a cost pressure for the trust without any income...and in a business world, that inevitably leads to one conclusion.

So have a think about Plan B. It doesn't involve anything too complicated...maybe something as simple as buying your departmental manager a cuppa and asking..." what can I do to help?", maybe a beer to your GP colleague "how do you run your surgery?" It's a start- believe me, I have been doing it for nearly 5 years now- been the best education I have had- beyond any Deanery training course or Kings Fund event you will attend. 

A favourite tagline of Hollywood movies is " A storm is coming"...anyone who has dealt with the NHS will tell you this one is potentially the most destructive ever. Plan A to resist it seems to be on the back foot...so whilst we keep our fingers crossed for Plan A to succeed, make sure you have a Plan B in your back pocket. 
As Mahatma Gandhi once said..."Adaptability is not imitation. It means power of resistance and assimilation"....We wait with bated breath as we test the truth of that statement.

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