A lot of my work is about transferring the power to commission NHS healthcare from one side of a room of commissioners to the other.
On one side is the PCT, which will not exist in 24 months' time, and on the other are GP commissioning consortia that barely exist now.
There is concern about whether consortia will become part of a national organisation, the NHS Commissioning Board, which is publicly pledged to grip the whole transition from the centre. PCTs have experience of resisting (or giving in) to the centre and warn how oppressive a centrist NHS is.
Luckily GPs need little warning. Recently I was present on two occasions when GPs demonstrated they can bring game-changing skills and expectations to counteract this.
The first was working with a local authority to set up a shadow health and wellbeing board (HWB). This will be a vital body that integrates different commissioning responsibilities for local government and GPs.
The meeting was about moving forward on the draft terms of reference for the HWB.
There were about 30 minutes of desultory discussion with the leader of the council showing not much enthusiasm about chairing yet another body.
Then one GP said she felt the HWB looked like a bureaucratic takeover and that it did not seem the sort of body that could actually achieve things for people's health.
Another GP joined in and soon it was clear nobody around the table wanted to set up an organisation which was basically bureaucratic. One of the GPs suggested setting a series of 'task and finish groups' (small groups that carry out specific, time-limited pieces of work) on issues such as the frail elderly, where we can have some immediate, joint impact. A rejuvenated council leader said they would really like to chair that.
The second occasion was a meeting with 20 PCT non-executive directors (NEDs) and some GPs about transferring powers and duties that must take place by 1 April 2013. Until then the NEDs remain responsible for receiving NHS funding and need to ensure good governance. The meeting's first half was about trading our anxieties. A GP then said we seemed to be going about things in the wrong way, that what was important is how GPs and PCTs could start taking new risks straight away, as patients need a better value-for-money NHS. This could be achieved only by much better appreciation of risks. The NEDs became animated by a real, not abstract discussion which ended on a much higher note.
These turnarounds were caused by GPs speaking out against the expectation that a bureaucracy would develop. Keep doing this and something new could actually emerge.
- Paul Corrigan is a management consultant and former special adviser to Tony Blair. More at www.pauldcorrigan.com