I’ve just been appointed as clinical lead for informatics at Bedfordshire Clinical Commissioning Group.
I’m one of the earliest appointees to this new type of role. But where do I start? By implementing a common, upgraded version of Windows? By establishing a community of interest network? By worrying about interoperability?
None of the above. I want to start with the people; and not the ones you might naturally think about, either.
Who are the people?
The NHS is remarkably bad at considering the needs of its workforce. ‘Managers’ don’t run the NHS, nor do ‘doctors’ or ‘nurses’. It’s people who do the jobs; some as clinicians, others as managers and support staff.
Yet the NHS ignores these individuals almost completely. Instead, it creates systems – protocols, pathways and IT – which it imposes on its staff. Sadly, the only people the NHS routinely thinks about are its patients.
I want to take a different approach and consider the needs of all the individuals involved – clinicians, managers, staff and patients alike – and design the CCG’s informatics to meet their needs.
In doing this, I think we’ll achieve a first. We might even trigger a revolution in healthcare management.
From ineffective meetings, good ideas can grow
This train of thought began 18 months ago. It was triggered by a grand conclave of all the practices involved with the CCG, which was held to decide the best way forward.
The meeting was peculiarly ineffective. Doing it by the book, the CCG’s leaders asked those of us attending a variety of rather vague and open questions, which we then discussed in small groups prior to reporting back to the main meeting.
But the plenary meeting ran out of time. So, despite our considerable efforts we were unable to provide feedback in anything other than the most general terms.
Never mind. At least the exercise could be logged on our personal development plans as ‘CCG meeting attended’ (time spent: three hours; impact: ‘next to nothing’).
Our CCG leaders are well respected, had been completely open, had honestly asked for our opinions, and had genuinely wanted to listen.
The problem was that we, the practices, felt we had wasted our time discussing ethereal management principles that we weren’t that concerned about, while the burning questions we did have weren’t even up for discussion.
Which is why that evening, as an ordinary GP, I went home to write my first ever paper for the CCG, on ‘Ideas for engagement and delivery’.
This emphasised that communication is a two-way event, with listening just as important as speaking; and that the best way for the central CCG to engage with its member practices is to remember to give others the chance to set the agenda.
And that way lies true engagement between clinicians and managers.
Pushing the Big Red Button
I suspect many GPs don’t appreciate the complete change in attitude the inception of CCGs is going to bring about.
In the past, the primary care trust was the boss and the practices were the underlings (and some PCTs were considerably more bossy than others).
But from 1 April there will no longer be any question of ‘us’ and ‘them’, ‘master’ and ‘servant’, because the CCG is ‘us’ — the member practices.
There will be no dichotomy between the interests of manager and clinician, because the interests of the central CCG and of its member practices will be one and the same. What’s good for the practices will be good for the CCG, and vice versa.
We are all in this together. The needs of clinicians, managers and staff are equally important. As an informatician it will be my job to ensure that the communication of information occurs in whatever way, and to whatever degree, that each individual NHS worker needs.
So what am I planning in response to all this?
Our CCG is setting up a password-protected extranet which will hold all the practical and relevant information that its clinicians, managers, staff and practices need.
That means: up-to-date contact directories; news; details of clinical pathways; referral information; formularies; incentive schemes, and so on.
I want it to be so relevant, so comprehensive, so user-friendly and so up-to-date that the clinicians feel there are only four things they need to have on their desktop; their clinical system, Microsoft Office (or its equivalent), their email reader and the CCG’s website.
I want one of its important features to be the ‘Big Red Button’ or BRB, which people will be able to press to send immediate concerns to the central CCG, without first needing to find out which individual or department is technically responsible.
Do you suspect your local hospital is gaming its Choose and Book targets? Hit the BRB and tell the central CCG. Have you though of a way to save thousands of pounds a year in referral costs? Click the BRB.
At the receiving end of the BRB I plan to have a response team (which I’ve nicknamed ‘the Rottweiler group’).
This will consist of CCG staff charged with immediately acknowledging the email, then re-routing it appropriately and not letting go of the problem until it’s been properly addressed, with lessons learned and action taken.
Look, no jargon
As a result of all this, the central CCG will be disseminating relevant information. It will know what problems are troubling its member practices, and will start addressing them (and what is more, be seen to be addressing them).
It will also take every opportunity to acquire good ideas generated by practices, clinicians and central CCG staff. In turn, the practices will know they are being warmly listened to by the central CCG.
Everyone — clinicians, managers and staff alike — will have increased confidence in everyone else. Very importantly, the personal needs, ideas, concerns and stresses of everyone working within the entire CCG will be acknowledged.
Meanwhile, I notice that I’ve written my first column on CCG informatics without mentioning any details of hardware or software.
That’s because I’m convinced it’s the people who come first, and the systems second. Gain the hearts and minds of all NHS workers, listen to what they are actually saying, respond to it – and what you then develop for your own CCG will be welcomed with open arms, surely?
About the author: Dr John Lockley is clinical lead for informatics at Bedfordshire Clinical Commissioning Group and a part-time GP.