Chris Lancelot - GPs suffer the overarching failure of NHS management

I am becoming increasingly disillusioned with the high-level organisation of the NHS. Clinicians do their best to help the patients while being obstructed by managers with their imposed, dysfunctional systems.

Yet when the NHS is expected to save £20bn the response of managers isn't to streamline their systems to make them cost-effective and fit for purpose. Instead, they expect others to adopt time-consuming workarounds.

Take Choose and Book: a new system which often didn't fit properly on existing hospital hardware and software, nor integrate with most hospital records. Outlay and rewards were split asymmetrically: it cost GPs' time, while hospitals and politicians reaped the potential rewards.

It was introduced piecemeal. It constantly changed its nature - always unhelpful when bedding in new systems. Clinics appeared and disappeared on a weekly basis: and while Choose and Book offered what GPs didn't need, local hospitals refused to offer what GPs actually wanted, such as named clinician referrals.

NHS managers then blamed GPs for their 'poor uptake' of Choose and Book. These low scores often turned out to be false.

Finally, there was high-level managerial blindness for the actual frustrations that users encountered, with no co-ordinated DH attempt to censure hospital managers who gamed the system to hit their waiting time targets.

In short, Choose and Book presented an NHS-wide problem that couldn't be solved with purely local initiatives. To rectify these shortcomings the DH needed to have an overarching appreciation of the whole system, the wisdom to understand its underlying problems, the sensitivity to recognise the stresses it placed on clinicians, and above all the power to force through necessary nationwide changes in both primary and secondary care. It failed.

Choose and Book could be brilliant. Were it configured properly it could save the NHS millions and massively ease clinicians' administrative work.

That it doesn't is a stark reminder of the incompetence of the DH over creating and maintaining a national NHS infrastructure which is fit for purpose.

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