Welcome to the most exclusive club in the NHS
BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7318 (Published 11 December 2013) Cite this as: BMJ 2013;347:f7318
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Having worked as an Honorary Consultant for two members of the Shelford Group, I can confirm that there is no need for general practitioners (GPs) and clinical commissioning groups (CCGs) to be afraid of them. Here are my key tips for taking on these members of the 'most exclusive club in the NHS'.
1. Form your own consortia. General practices can work in federations and networks to share resources and expertise. CCGs can come together in joint commissioning activities. Working in larger groupings - whether it is of general practices or CCGs - will give you more bargaining power and greater consolidation of expertise to challenge the members of the Shelford Group.
2. Become skilled in using the language of evidence-based medicine, healthcare evaluation and data-driven healthcare in your dealings with the managers of the Shelford Group NHS Trusts. You will soon discover that many NHS managers are poorly trained in these essential components of modern healthcare delivery and in using NHS data to evaluate the performance of health services.
3. The Shelford Group Trusts may be large but like many NHS Trusts they often operate on very narrow financial margins and even a small shift in GP referrals (and hence in their income) can destabilise their clinical services - and sometimes even an entire NHS Trust. Use your commissioning power to move referrals to NHS Trusts that are more flexible and more responsive to your needs. If your CCG won't do this, then a group of practices can - under NHS hospital funding arrangements, money follows the patient. Write to the Finance Director, Medical Director and Chief Executive of the Trust to let them know what you are planning. The more GPs that contact an NHS Trust on a single issue, the more effective you will be at influencing the Trust.
4. Take back power from NHS England and Commissioning Support Units (CSUs). Many NHS managers in the former NHS commissioning organisations obtained new positions with NHS England and CSUs. What are all these managers doing and what value for money do they provide? Hold them to account for any top-slicing of your budgets to fund their activities and make a case with the Department of Health that consortia of clinical commissioning groups can take over many of their functions (and thereby make their managers redundant).
5. Finally, NHS managers often hope - that as busy clinicians - you won't have time to keep on dealing with them on a single issue. So if you have a strong case, be tenacious and don't give up in your dealings with them.
Competing interests: I am currently an Honorary Consultant with the Imperial College Healthcare NHS Trust and was formerly an Honorary Consultant with University College Hospitals NHS Trust. Both these NHS Trusts are members of the Sheldon Group.
I have much sympathy with the Shelford group. But they really do need to visit their wards a bit more.
Under 'Action on nursing' they state 'a paediatric cancer ward, for example, needs twice as many nurses as a geriatric ward'. Gets maybe, but needs? I think they have it the wrong way round.
A typical patient on a geriatric medical ward has an acute physical illness and dementia complicated by delirium. Half or more (each) have delusions, hallucinations, anxiety, depression, apathy, or sleep disturbance. Two thirds need help transferring from bed to chair, half need help feeding or are incontinent [1]. Most will be at high risk of falling. They need emotional and psycholgical support to prevent distress, and access to therapeutic and diversionary activity to maintain skills. Families are likely to be elderly and stressed [2]. Enhanced provision makes a real difference [3].
On the paediatric ward a parent will be expected to be present a lot of the time. After a few days debility the child patient will be up and about. The ward will get the pick of the bright nursing graduates, and a generous supply of doctors and AHPs.
The lack of awareness of the needs of elderly patients in our acute hospitals is worrying
References
1. Goldberg SE, Whittamore K, Harwood RH, Bradshaw L, Gladman JRF, Jones RG. The prevalence of mental health problems amongst older adults admitted as an emergency to a general hospital. Age and Ageing 2012; 41: 80-86. DOI: 10.1093/ageing/afr106
2. Bradshaw LE, Goldberg SE, Schneider JM, Harwood RH. Carers for older people with co-morbid cognitive impairment in general hospital: characteristics and psychological well-being. Int J Geriatr Psychiatry 2013; 28: 681-690. DOI: 10.1002/gps.3871
3. Goldberg SE, Bradshaw LE, Kearney FC, Russell C, Whittamore KH, Foster PER, Mamza J, Gladman JRF, Jones RG, Lewis SA, Porock D, Harwood RH. Comparison of a specialist Medical and Mental Health Unit with standard care for older people with cognitive impairment admitted to a general hospital: a randomised controlled trial (NIHR TEAM trial). BMJ 2013;347:f4132 doi: 10.1136/bmj.f4132
Competing interests: No competing interests
The only thing these chief executives will be benchmarking will their own pay & perks.
With the only noticeable outcome being steep rises in the cost of employing these dynamic and inspirational people.
They are so wonderful: they should be supported and assisted in working in other healthcare systems so that others may benefit from their abilities in commissioning glossy reports and having lots of very important meetings. A loss the NHS will have to bear.
Competing interests: No competing interests
Re: Welcome to the most exclusive club in the NHS
After years of quiet anonymity I was shocked on reading Hawkes' article that I am now a Group; indeed, possibly an honorary member of the most exclusive club in the NHS. Like Hawkes, I do hope that they are not "fat cats monopolising the cream". A Group I can cope with, but an Enquiry would be upsetting, while a Scandal would be hard to bear.
Competing interests: No competing interests