Let’s Stick Together – Part 2

6th December 2016

“Alone we can do so little; together we can do so much”

Helen Keller

On my last blog, I talked about the importance of GPs working collaboratively for mutual benefit.

It is clear there is also a need for the wider team in health and social care to work together, for many of the same reasons.  This is clearly documented in Simon Stevens’ Five Year Plan three years ago, and also reflected in our local STP where the main message was “collaboration not competition”.  There is a clear feeling that unless we are able to work more efficiently in this way, the current service will be unsustainable.

We need to develop a mind-set of “system think” rather than “single organisation think” that we have had in the past.

At a recent meeting of the King’s Fund in London, one of the other speakers, Jonathan Sargent, noted that it would be difficult to set up a system more perfectly set up NOT to encourage people to work together, than the NHS.

So what needs to happen?

• System think – we need to start thinking beyond our local organisation, practice or area and look at the wider picture. Work needs to move “downstream”.
• Financial incentives – the perverse incentive structure to encourage organisations to balance their own books even at the expense of other organisations within the health or social care system needs to be urgently addressed. Some of that work is already happening with the agreement of Ipswich Hospital moving onto a “fixed budget”
• IT – most organisations within the system – hospital, primary care, mental health, social services – work on different systems. These don’t all need to be made compatible but the ability to share information across them does need addressing.  Locally, services other than primary care are using SystmOne computer system and that puts us in a good position to begin to drive that change
• Clinical model – clinical model needs to be developed and changes made looking to address certain outcomes required. The emphasis needs to be on changing outcomes rather than changing the system.
• Commissioning – commissioners need to identify the outcomes they wish to achieve and allow the providers to work together to deliver them – it’s what they are good at.
• Engagement – all organisations need to be genuinely engaged – lip service is not enough.

There are another two key players in this wider view that must play their part. A common theme in publications has been on the importance of improved patient self-care. We must help our patients take personal responsibility about use of resources and clinicians challenging inappropriate use or demands must be supported.

There needs to be considerably more honesty from politicians, the Department of Health and NHS England about these challenges and they must address the difficult issues rising from their policy decisions not leaving it to front line clinicians.