The NHS needs new answers

By Dr Michael Dixon

This year's NHS Alliance conference in Manchester is set to be primary care's "finest hour". An NHS beset by limited, zero or even negative economic growth is having to think again. How can we improve patients' ability to help themselves, improve their personal health and develop better health within the wider community?

How can we de-professionalise medicine and conserve the precious resources of people and technology in both primary and secondary care for when they are essential?  The NHS needs new answers. 

Central targets, maximum waiting list times and even secondary care based quality initiatives will not achieve any of these aims. The penny is beginning to drop for even the most recidivist Strategic Health Authority chief executive, the most anti-clinician senior manager or the most centralist clinician, manager or politician at the centre. 

The answer, as it always has been, lies in primary care. Only here, as providers and commissioners, can primary care clinicians effectively enable self-help, encourage better personal health and take on a new role as local health physicians ensuring the best health for the greatest number.

It is a revolution in thinking that will require a revolution in behaviour in so many different areas of the NHS. 

First of all, frontline clinicians must develop a hunger for developing local health and the ability of patients to help themselves both as providers and commissioners. No longer should they be the unwilling victims of whatever hospitals want to provide any more than they and their patients should continue to be the recipients of ineffective health initiatives landing from outer space. Developing local health must become the responsibility of every frontline professional and patient – an organic, systemic and comprehensive process of change that wins hearts, minds and eventually lives. 

Then, we need to develop an effective infrastructure of management to support and co-lead this process. Practice managers, who can look beyond the patient consultation to the population, and PCT managers who can emancipate local clinicians and managers to re-design services available. Then there are the patients themselves, who need to be an intrinsic part of local health provision and service redesign – not consulted at the last minute. 

That will require immense change at Strategic Health Authority and Department of Health level, where both now see themselves as supporting local changes in innovation rather than trying to mould and straightjacket them.  They will require a radical re-haul of how the centre of the NHS operates – moving its focus to commissioning and visibly involving PCT and practice based commissioners – clinicians and managers – right at the top. 

It also seems so obvious.  Only tribalism and self-interest lie in the way of a sensible solution that brings together clinicians, patients and managers at local level and also represents them and understands them at national level. These times of political and economic instability are also times for primary care to advance its case.  We have articulated it clearly and politely. If frontline clinicians and managers, practice based commissioners and PCTs still feel, this October, that they are minions at the bottom of a self-serving centralist system then now is the time to kick down the doors, grab the controls and enunciate a new set of rules. The decision must come from within.  From the patients and people themselves and the clinicians that look after them. Is the system serving you? If it is, then now is the time for primary care to consolidate its role in creating a sustainable NHS. If it isn’t, then now is the time to man the barricades and create a new order.