Wednesday, 7 December 2011

Power (What's in a word?)

One word has stood out to me over the past few weeks. It was said at the excellent NHS Alliance Conference, on stage, and struck me as an interesting concept.

The word was 'power'. A small word but significant, and one which, in the context of NHS reform, has usually been used with reference to GPs recently. I think it's unhelpful.

The word 'power' may apply in some ways. GPs and other clinicians do have some power to influence commissioning decisions, to determine strategy and to spend real budgets. However this may have caused some dissatisfaction as 2013 approaches and the reality of commissioning complexities become apparent. GPs and other CCG clinicians have had power given to them, but now (before 2013) we need to accept and learn how to share power, let go of some roles and ensure that the system works in the best way for the patients.

What does letting go mean? As an example, it is clear the NHSCB will have a significant role in commissioning, including specialised services and primary care. Health and Wellbeing Boards will have a role in overseeing strategy and commissioning intentions for communities. Commissioning Support Organisations will provide intelligence, manpower and support. Local Authorities will increasingly expect an input into decisions which would be better taken jointly and affect social care. Secondary care services will hope for integrated working and planning of services. Managers are vital and key if we are to succeed.

What then, is the role of the CCG in this? Are we, as some suggest, really commissioning nothing? I'd argue we have a key role in ensuring this system works, in representing our patients and striving for improvements. We are used to working with consultants and other agencies when we care for patients, are often strong patient advocates, and coordinate complex care pathways for individual patients daily.

So are there better words than power? I prefer 'responsibility' and 'influence'. We have a real responsibility to commission effectively for our patients, to ensure they get the best services and in the right location. We have a responsibility to ensure we use resources appropriately, so that we protect patient care and have the ability to be flexible and improve services in the future.

The key is 'influence'. We must allow patients and the public to influence the way we commission and define our responsibilities. The contract planning underway is a current challenge for us - can we meaningfully engage to ensure we contract for outcomes that matter to patients? Can we plan for next year and include priorities that affect our populations? Can we deliver the better outcomes, working jointly with providers to plan better services? This will be the test for CCGs in the future.

So let's try to move away from 'power', and towards responsibility and shared influence. Build relationships that deliver, let go where appropriate and ensure the system works for patients.

To quote Thomas Jefferson:

I hope our wisdom will grow with our power, and teach us, that the less we use our power the greater it will be.

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