It’s not been a habit of mine to quote Chinese philosophers to be honest, but I happened upon this and it seems very apt for the times and I feel I need to share:
‘In the midst of chaos there is also opportunity’ Sun Tzu, The Art of War.
Since the announcement on March 13 about the impending abolition of NHS England (NHSE), the reduction of the integrated care board work force by 50% and the discussions around the new GP contract, the NHS management world in a sense feels very… chaotic.
I would imagine there are many GPs who won’t notice much difference, their interactions with NHSE and the ICBs will be limited to the occasional briefing and being informed of medicines shortages.
I would wager that a fair few GPs still don’t know the role that NHSE played in the health care landscape, and I’ll be honest I am not sure I fully understood until recently.
Former Conservative health secretary, Andrew Lansley, the man who led the charge on setting up NHSE in 2011, had this vision that somehow it would protect us from political interference.
Simple ideas like removing it entirely from party politics and making it a cross-party issue didn’t seem sensible, so a whole organisation was created to keep the executive function away from the political meddling of the government.
Except that is not how it has felt to us on the ground, the establishment of NHSE has made little material difference to our working lives and has been a source of confusion for most.
Those of us in medical leadership positions have had more exposure to NHSE and I would like to say for the record I have worked with some excellent people along the way.
For those people who are now under threat of losing their jobs I am truly sorry as I know how hard many of you work to make the NHS as good as possible.
The thing is, I don’t think anyone believes that NHSE protected us from political interference and the results of its abolition are very difficult to predict. Though the change feels seismic to some of us the fallout is unclear.
‘Vertical integration’ is the buzzword of the moment, and we are now being asked to consider this, and all its implications, without as much support from the integrated care board (ICB) and none from NHSE.
Our hospital trust is moving to a ‘host provider model’ which will have implications around community care and as a result it will be increasingly involved with community resources.
So, what opportunities arise from this chaos?
Those GP leaders who are cognisant of the system and all its vagaries will be well placed to lead through this turbulent time.
There are very few clinicians that have an understanding of the system in its entirety and the possibilities that working differently will bring.
In my view, primary care at scale needs to step-up as the provider it should be and represent the whole of primary care where it can.
Where well established and well run, this can be led by PCNs.
At place level we need to pull up a chair, advocate for our work and make sure our strengths are realised.
We need to join together in a meaningful way across PCNs and community trusts, stop arguing about the price of biscuits, and move into this space with the confidence of knowing that we are making the system better.
Those areas with no real primary care at scale infrastructure should be supported by those that do. They should be shored up, so they are able to weather the coming storm.
For there is a storm, a huge storm on the horizon and unless we work together, we have no chance of surviving it, we will be subsumed by the chaos of these political waves.
Dr Sian Stanley is clinical director of Stort Valley and Villages PCN, East of England CD Representative, NHS Confederation and a GP partner in Bishops Stortford, Hertfordshire. Read more of her articles here.