Editor's blog Friday 19 November: Bits from day one of the NHS Alliance conference

The 2010 NHS Alliance conference opened with a vigorous address from NHS Alliance chair Dr Michael Dixon, calling the primary care team to arms behind the vision of a primary care-led NHS, despite over a decade of false dawns.

Describing the “last gasps of secondary care-dominated system disconnected from front-line clinicians", Dixon implored delegates, “do not let this chance slip through your hands. if we fail the NHS, we'll be done for”.

He warned against the risks to the profession of not making the reforms work: "Do not allow history to call general practice and primary care timid, workshy, selfish or small minded. We must not allow fear, apathy, greed or laziness to prevent this becoming the NHS’s finest hour".

He focused attention on the need for resource use awareness: "We cannot act Pontius Pilate to whatever goes on outside our consulting rooms".

He also located NHS Alliance’s pioneering work as influential to changed perceptions of the need for greater primary care involvement in NHS management, referring to its series of ‘Engaging GPs in the NHS’ documents of a few years back. “No Minister, no one from the Department of Health attended the launch of any of these.  We were told they were “unhelpful”.  We were told we were trying to solve a problem that did not exist”.

Dixon also reflected on the questions and ideas NHS Alliance had found in its surveys and listening events for members: “how we could make the commissioning process fairer for new GP consortia.  How could they possibly get on their feet if they were already saddled by huge deficits?  How could they keep within budget if they could not control the costs?  How could they commission when the data and our current commissioning mechanism are no longer fit for purpose?

“You proposed that tariffs should only be a maximum.  That we should have a commissioning system, where the providers put in timely bills, which are paid when and only when the service has been rendered and it has been shown to have been rendered.  Where budgets were severely challenged, we advised that GP consortia should be able to set cost limits on their providers. We must be radical if we really want to redress the historical imbalance between commissioner and provider, which has so blighted commissioning in the past”.

He suggested that a possible solution would involve “insisting that all NHS providers – third sector, general practice or traditional private sector - should have open accounts in their dealings with NHS commissioners.  Then we would know exactly what value we were getting.  If we really want a fair system then transparency, transparency, transparency must become our mantra!”

Touching on the importance of integration with social care, the need to provide more preventative primary care services and also a values-base, Dixon emphasised that the NHS Alliance’s GP Commissioning Federation “is committed to supporting all patients and all GP consortia at every level of development and achievement. These reforms must never be allowed to become a way of supporting only the elite and the strong or lining the pockets of GPs, managers or big business. That is not what we have been fighting for, all these years”.
Second Rear Admiral Lionel Jarvis QHS, Assistant Chief of Defence Staff, gave a striking and moving presentation on managing continuity of care from the battlefield in Afghanistan, delivering a continuum of care from the point of wounding to rehabilitation and beyond, by a cohesive team of professional military medical personnel.

Emphasising Hippocrates’ dictum that “war is the only proper school of the surgeon”, Admiral Jarvis emphasised how quickly military medics diffuse demonstrable and evidence-based good clinical practice, and noted that the ongoing learning and successful care had improved the survival rate of soldiers injured in battle between the first and second Iraq war by 50%. NHS colleagues constantly observe to Admiral Jarvis’ team how far the military are ahead in trauma care.

Professor Sir Bruce Keogh, NHS England Medical Director, spoke on improving productivity and quality. He pointed out that clinicians have been entrusted with the nation’s precious baby of the NHS, and with that great responsibility come great risks. the abolition of the intermediate tiers of SHAs and PCTs represents a unique and bital opportunity to genuinely change services and think outside the box, Keogh suggested, especially in establishing who would be the senior clinician in charge across a locality or region for individual disciplines of clinical care.

He strongly emphasised that quality care is likely to be cheaper care. But Keogh challenged the medical profession for past failures “Have we always stepped up to the plate? Why did it take an irate Secretary of State to get real action on MRSA? What about venous thrombo-embolism? We’ve failed to address that: a failure that’s been killing 25,000 a year; we as a profession should be lading that. We haven’t always done it: now is our chance”.

Keogh said that the DH want Alliance members’ “help to develop detail so this works properly, with no unnecessary bureaucracy or crazy financial structures. We must ask ourselves three questions:
what will this change and make better for an average GP?
what will this change and make better for an average patient?
how do we protect the future of the NHS, by being seen to provide value-for-money in innovative customer-focused ways?”