A Commissioning Equation
NHS commissioning re-organisations. It would seem that every time there is one, the intentions are good and the heart of the matter is clinical leadership. And often, after a short time the selected group of clinical leaders whether that is in a DHA, a PCG, a PCT, a PBC or a CCG get let down by something, and the gears grind to a halt.
The two main pillars of UK healthcare improvement policy are clinical commissioning and increased competition. The last 20 years of strategy for commissioning improvement has always been a re-structure and the magnanimous wish to get more clinicians involved.
And yet, if you were in charge of commissioning in the UK-which part of this commissioning equation would you change first? Which part of the equation is easier, cheaper and can be changed within the shortest timescale?
A=Commissioning in the NHS is alive with conflict of interests. Primary Care professionals who now lead commissioning organisations cannot do it without being subjective. Medicine itself is full of interpretation and opinions. Why would clinical commissioning be any different?
B=Clinicians are risk averse. Their working life is driven by evidence and standards. Commissioning new models of care relies on bravery and often a low evidence base. How many times have you heard that organisations need transitional funding? Operate the old model, whilst you introduce the new.
C=Healthcare Information and Data is fragmented and lacks uniformity.
D=Managers in the NHS administrate annual performance and contract rounds and regulation tick-box exercises. Do NHS commissioning managers have experience of leading autonomous organisations, creating new businesses and affecting new supply chains? Do Hospital Chief Executives have the courage to reduce their infrastructure base and income targets without a transition plan?
A + B +C+D=the current state.
So what would we change?
We would actively change D and quickly before the gears grind to a halt. In fact it’s the only thing we can really affect in a short term.
We should seek to enhance competencies into healthcare commissioning and more importantly leaders in provider organisations. Entrepreneurs, risk takers and brave people who can provide the equation with balance. And contrary to the current policy direction of seeking these inputs from the big US based technology corporates, conduct some proper diligence on where and how they work.
#EHRBacklash will give you some idea.
Seek the people from within the NHS because they are there, and in the places you never thought or wanted to look.