Osiris Training

Following the publication of Next Steps I want to spend the next few posts looking specifically at the way in which the reform programme has been developed in a number of policy areas.

The most significant remains the transfer of Commissioning to GP Consortia.

Whilst Wednesday’s reform programme still aims to leave the “end state” of GP Commissioning in a similar place to that in which it was before it was published, the tone of the way in which this is going to come about has changed.

There is a recognition that even if GP are the right people to commission NHS health care at the moment, in nearly every part of the country where this is planned to happen, the Consortia that will carry this out do not exist.  So if we are going to have the principle of GP Commissioning in practice, over the next few years we are going to need the development of hundreds of real organisations to carry this out. Since very few of these organisations exist at the moment, they are going to be created from scratch.

Next steps provides us with more detail on how the Government thinks this is going to take place.

There is the nearest that this government comes to self criticism when it recognises that its previous proposals of a “big bang” approach to Commissioning  - where one day NHS health care would be commissioned by PCTs and the next by GPs  - will not work. Instead they want to see a programme of pathfinders that have started already with those designated last week.

There will now be a rolling programme of pathfinders from now until April 2012. The Government expectation (4.126) is that any group of practices that wishes to will be able to do so. They recognise (4.127) that they need to promote leadership development and help consortia with OD. The Operating Framework suggests that the NHS spends a sum of money on this (although whether GPs will be allowed to spend it or it will be spent by PCTs and SHAS will be interesting to see.)

All this adds up to (4.129) a carefully staged transition towards full implementation of the new commissioning arrangements. During the first year, 2011/12, emerging consortia will have the opportunity to plan how they intend to carry out their future functions. During that year they will identify those PCT staff that they want to work for them or identify other posts; engage with the NCB PCTs and SHAs to find out where there will be demand for external skills and consider how they might support consortia; manage the transfer of IT and the transfer of contacts and develop partnerships with local authorities and Healthy and Well Being boards.

Next steps contains many more references to the transfer of PCT and SHA staff to GP Commissioning consortia than were in the original White Paper. Given the likely issues in the transition period, ’NHS bosses’ (the cause of all the trouble in July) have become the saviours of the NHS by December.

There is even a recognition that by the end of March 2012 there may be some areas where the consortia are not yet ready. Under these circumstances the NCB have to create organisations to step in.

There is an interesting and potentially important issue about geography. At the moment most nascent GP consortia and certainly the ones that exist, all lie within a single boundary. Section 4.16-4.21 recommends that whilst consortia will have to perform certain geographical functions, for example access to A and E), “it would not automatically follow that every one of the practices in a consortium has to be physically located in their area, nor that all practices in a consortium have to be next to each other.  4.21

Whilst I don’t anticipate many of the immediate consortia having anything but geography as their organising focus, this will be allowed to change over time.  This has very considerable implications for the future. It provides the possibility that – for example – that there could be a consortium of GPs that covers not just an area of inner London but could also be linked with inner city GPs in other cities. In this way specific commissioning expertise could be linked to specific localities to provide better expertise.

So if GP commissioning scales up to bigger organisations they are not restricted by having to be next door to each other.

Next steps also continues to argue for Consortia of varying size. They recognise that for consortia to carry out specific functions they will need to work together. The issue of size concerns the original consortia and the organisations that the consortia work with in order to commission, for example, tertiary care.

This meets Corrigan’s rule about the size of administrative boundaries – whether they are NHS or local government organisations. All administrative boundaries – however large or small the population within them is – are always either too large or too small (and frequently both). What that means in practice is that if you are a local education authority you are usually much too big to deal with, for example, nurseries or too small to have a range of sixth forms within your boundaries.

The same is true for NHS commissioning. You are either much too big to be able to work with a street by street risk register of patients, or too small to be able to commission tertiary care.

The anxiety about GP commissioning consortia is that they are too small to buy secondary or tertiary care. But the answer to this is that small consortia buy in those skills from bigger organisations.  Whatever their size they buy in the skills above or below them to work with the smaller and bigger parts of the locality.

Most of next steps stress over and over again the fact that the Government is not going to tell GP Commissioners how to organise themselves. But this changes when it comes to paying for their organisations. The Bill will provide the Government with the ability to set a control total on what GP Commissioning organisations can spend on administration.  So you are not going to be told what sort of organisation you can run but you are going to be told what you can spend on running it.

This is daft. A wise GP Commissioning Consortium will be able to find their way round and through this be reclassifying what they spend on what. I suspect the Government will then employ a set of inspectors to go round checking up what people are really spending their money on. This is silly and it won’t work.

In any case now the Government has announced that the new Chief Executive of the National Commissioning Board is going to be the old Chief Executive of the NHS, I suspect that the GP Commissioning Organisations will take the spend on their salaries from the starting point that the NCBs spend on his.

How many people end up earning more than the Prime Minister will be an interesting issue.

The government has confirmed it is to push ahead with big structural changes to the NHS in England.

After a public consultation, Health Secretary Andrew Lansley said the reform agenda was “on track”, despite concerns from health unions.

Primary Care Trusts are to be abolished by 2013, when GPs will plan hospital care and manage budgets to pay for it.

Meanwhile, hospitals have been told their funding could be cut if patients are forced to share mixed-sex wards.

The Department of Health has carried out a public consultation on reform plans set out in a White Paper, receiving some 6,000 responses.

It has also published its “operating framework” for the NHS, setting out priorities for the next financial year, including allocation of money to PCTs, ahead of their eventual abolition.

Mr Lansley said £89bn would go to PCTs for frontline services.

And he told members of the Health Select Committee: “And of course in addition to that, there is a great deal of scope – and necessity – for the generation of savings through improved productivity and efficiency and quality gain inside every part of the service, which will enable us next year, I hope, not only to meet demands but to improve the service we offer.”

‘Massive upheaval’
But the Shadow Health Secretary John Healey said it was the wrong time to be making such big changes to the health service.

He said: “This is a massive upheaval and a massive distraction and it puts a pressure on the NHS which it could live without at the moment.”
PCTs are local organisations which control 80% of the NHS budget and are responsible for providing services such as hospitals, dentists and opticians.

All 151 in England are set to be scrapped, along with the next tier of organisation, the Strategic Health Authorities – 10 of which operate at a regional level.

In future, the bulk of the NHS budget will be allocated to GPs working in consortia across the country.

Around 50 GP consortia have signed up as “pathfinders” to manage their local budgets and commission services for patients.

Earlier, Mr Lansley told the BBC that, from next April, hospitals would be “held to account” if they failed to get rid of mixed-sex wards.

“We are not going to pay hospitals for providing a sub-standard service,” he said.
“Patients have a right to expect dignity and privacy and if there is a breach of that, that will be published.”

The NHS in England faces increasing financial pressures, not least the need to make up to £20bn in efficiency savings over the next four years.

On Tuesday, the Commons Health Select Committee said meeting that target would test the NHS to the limit.

The reforms do not affect the health service in Scotland, Wales and Northern Ireland, which are devolved to their national administrations.

When the future involves great uncertainty… about what services the politicians expect to be provided, about funding, and about the employment prospects for managers and staff… this manual’s 52 concise and questioning reflections on management issues that can arise anywhere succinctly bring them to life.

Sharing, studying and discussing them will help managers respond successfully, by developing greater flexibility to:

• become comfortable and skilled at developing their management skills on the job
• recognise that on the job is the best place to learn what their organisation needs, as what is right for one organisation at a particular time may be different at another time or in another organisation
• develop the critical thinking skills that will help them meet this need for flexibility
• understand how their role as a leader is critical to helping those they manage to cope with uncertainty and respond constructively
• deal with issues that may be exacerbated during anxiety about uncertainty, such as poor performance, inappropriate behaviour, or poor attendance.

Wherever you work, in these times of uncertainty and tight finances, this manual takes the view that the best possible management is more essential than ever to making your organisation effective. For use in individual study, group sessions, supervision and mentoring, the empowering and adaptable material it contains can be used to:

• support and develop all managers in your organisation, not just a lucky few
• help them gain confidence and skills as part of their daily work
• play a part in creating a cost-effective management development programme that is expressly tailored to your organisation’s needs.

Click here to read more

You can obtain Equipping managers for an uncertain future on 30 day FREE trial direct from the following website www.russellhouse.co.uk at £25.00. Alternatively, you can order by phone (01297 443948) or fax (01297 442722).

During times of organisational change, the people who prosper are often those who have paid attention to managing their profile and image. 

What’s The Difference Between Profile and Image?
Your image is the impression you make on people who do not know you well.  Your profile is about how well known you are – and in what circles.

You can have a great image but a lousy profile (eg, everyone who meets you thinks you’re brilliant but hardly anyone does get to meet you because you’re hidden away in your office all the time).  Equally, you can be high profile but have a poor image (everyone knows you, mainly because you’re a notorious plonker).

The Ethics of Networking for Career Advancement
Using networking for career advancement is sometimes seen as trying to gain an unfair advantage, particularly in organisations which pride themselves on having scrupulously fair selection processes.  However, there are at least three reasons why networking can be seen as a legitimate approach to career development:

1.It’s how human beings work. When it comes to selecting someone for a new role, there are sound evolutionary reasons why human beings prefer to choose a familiar face.

2.For employers, it can be a more reliable way of spotting talent. If you’ve ever been on an interview panel and chosen the candidate who gave the best ‘performance’ only for them to turn out to be a big disappointment in the job, you’ll know why interviewers are often tempted to take their previous knowledge of a candidate into account.

3.Lots of jobs don’t get advertised – there is usually at least one person on each of my courses who has secured a job via word of mouth.

If you are looking to change jobs, you can view yourself as a product that some people would love to buy – if only they knew it existed.  Networking is your marketing strategy.

You Don’t Have To Sell Your Soul
Some people wince at the thought of networking – they picture themselves smarming their way round the building, using the right buzz words,  laughing slightly too loudly at the Chief Exec’s jokes and generally sucking up to anyone they perceive as being useful to them.

But networking doesn’t have to be like that.  It is possible to raise your profile in a way that feels comfortable and authentic.

10 Tips on Raising Your Profile

The trick is to look for make contact with more people, more often.  In particular, explore ways to be in touch with others who have similar (professional or personal) interests as you.  Ideally, you’ll find yourself in a room with individuals who share your passions, at which point networking becomes a lot easier and more natural.

1. Target particular people.  If there are a senior people who need to know that you exist, identify some fora in which you can make contact, for example:
•Working parties, project groups or committees
•Social events (eg, leaving do’s)
•Conferences
•In-house presentations and briefings
•Extra curricular activities.  A colleague regularly plays squash with one of the more senior managers in his organisation.  Times have changed – previously the smoking room was known as a good place to network.

2. Don’t overuse email. If you want to communicate with someone in your building, go and see them.  This gives you the opportunity to say hello to people in the lift or corridor.  One manager found herself waiting for the lift with the Chairwoman of her organisation.  Somewhat impulsively she asked, “Could I come and see you for 20 minutes?”  They subsequently had a very helpful conversation about career development for women in their (predominantly male) organisation.

3. Write an article for an internal newsletter or professional publication.  Your organisation’s communication department usually welcome offers of material.  It doesn’t have to be anything dramatic: just an update on work in your area, or a good news story.  Make sure your name is included at the end of the article.

4. Make a presentation.  Delivering a competent presentation or teaching session can raise your profile and help you be perceived as a subject expert.  Many people are nervous about making presentations, and consequently will admire you if you can do it well.

5. Undertake a small research project.  This can be an excellent opportunity to ring up someone with whom you want to raise your profile and ask, “Could I spend 20 minutes asking you some questions as part of a research project that I’m undertaking?”

6. Get a mentor, and ask them to help you to raise your profile.  A good mentor will introduce you to people to whom you wouldn’t otherwise have access.

7. Go along to local events organised by your professional body.

8. Shadow someone.  Shadowing is a recognised but under-used form of development which should be on your PDP if you are serious about raising your profile.  When I worked in the health service, I asked to spend a day with the HR Director for the whole of the English NHS.  He was very open to being shadowed; it was a fascinating experience and I established a contact that I would never have made if I hadn’t initiated the opportunity.

9. Attend meetings in place of your manager.

10. Put your name on your reports.  People whom you have never met will know about you via your written work.