Chris Lancelot: An open letter to the new health secretary

Dear Mr Lansley,

The GP Record, by Fran Orford
The GP Record, by Fran Orford

I was always taught that the best first-aider is the one who can keep his hands in his pockets for longest. In trying to fix our highly inefficient NHS please resist the temptation to jump in immediately with big-bang solutions - you may just do more damage.

New Labour tried to improve the NHS, but imposed big, centrally-designed solutions (like Choose and Book and Darzi centres), which took no notice of local conditions, and no notice of doctors' concerns. This approach doesn't work: the design and delivery of healthcare needs more than just managers and computer programmers.

Nature doesn't operate like this, either. Evolution (a highly efficient process) works by making many tiny changes, selecting the good and automatically discarding the bad, thus ensuring that each species becomes ever more adapted to its own niche. But evolution can only occur if variations are allowed to happen: imposing rigid solutions from on high stops systemic evolution stone dead.

By all means provide an overall framework for the NHS, but make it malleable. Allow local groups to experiment with healthcare delivery, keeping what works and discarding what doesn't: this way lies progress.

Difficult though it is for a politician, a hands-off, non-controlling approach may be the quickest way to solve most problems.

Next, please get managers off our backs. Some are helpful, but many are not, wasting our precious clinical time with their over-complex plans, time-consuming meetings, ceaseless demands for data and re-certification, and simplistic 'traffic-light' assessments. By all means discipline the small percentage of medical black sheep, but please target this sensitively, using methods that don't interfere with the rest of us.

Finally, please respect our views. Medicine is vastly more subtle than most non-clinicians imagine. Not only are doctors bright, observant people, but it takes 10 or 15 years to train us, followed by decades of experience. When we say that something won't work, we are likely to be right.

We are not your enemies. Like you, we want the NHS to succeed. If you listen to us, we will also listen to you, pulling together to make the NHS excellent for patients, cost-effective, and a great place to work.

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