Doctors should “just do it” to implement clinical visions

BMJ 2007; 335 doi: (Published 11 October 2007) Cite this as: BMJ 2007;335:743
  1. Robert Short
  1. London

    Doctors have to seize the initiative and make the changes they think are needed if clinical excellence is to be put at the centre of NHS reforms, a conference was told last week.

    This idea was endorsed by several panel members at the conference, held to launch a report on clinicians' views of the NHS reforms to an audience of more than 100 NHS trust chief executives, clinical directors, medical directors, and representatives of primary care trusts.

    The report, which contains “design rules” that are common to best practice, was produced jointly by the NHS Confederation, the body that represents most NHS organisations, and the Joint Medical Consultative Council, which comprises representatives of the medical royal colleges, medical schools, and the BMA.

    The conference featured a presentation by Vince Mak, consultant physician and clinical director of emergency services at the North West London Hospitals NHS Trust, who advocated an approach that he summed up as, “If you feel it is right, just do it.”

    Jonathan Fielden, chairman of the BMA's Central Consultants and Specialists Committee, said that consultants should act together and create, with their managers and patients, a culture that encourages clinician led reform. He said of such reform, “It comes fundamentally down to [this]: just do it. Have that freedom, take that freedom—which we hope that the next steps of the NHS review will also pass on—and deliver the sort of care our patients really need.”

    Mayur Lakhani, chairman of the council of the Royal College of General Practitioners, was positive about the report. “We know what needs to be done, which is around clinical excellence and around good local services,” he said.

    He said that achieving a clinical vision and focus on clinical excellence was crucial. He believed that the Darzi review of the reform of the NHS (see News doi: 10.1136/bmj.39360.699977.DB) was a good chance to restore a clinical vision to NHS systems.

    In advocating standards to support the vast increase in treatment to be delivered by primary care, he said that what was needed was “integration through clinical care pathways and clinical care networks. And we don't need permission to start that.”

    Summing up the conference, Bill Dunlop, chairman of the Joint Medical Consultative Council and a coauthor of the report, said that the next step would be to consult the organisations represented on the council on ways to take forward the many ideas in the report. “But I suspect that the time has come for it not all to be done centrally but devolved down to the bodies that can actually take it forward, with perhaps some gentle steering from the middle,” he added.


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