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A puzzling question


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Friday, 28 January 2011

A puzzling question

A story in this week’s Pulse points out that in the south-west, where all but 3% of the region’s GPs are already signed up to the pathfinder programme, 200,000 patients are covered by more than one pathfinder group.

Overlapping pathfinders making up a national jigsaw of poorly fitting pieces is a promising sign of authenticity.

The pathfinder programme has been criticised for its scale – with 55% of the UK population already covered and further waves of pathfinders to come, critics have said it looks less like an experiment than a rolling implementation programme.

But if the government had already drawn the map of the new NHS, as conspiracy theorists insist, then you might expect it to be tidier.

A programme with overlapping boundaries feels a lot more genuinely experimental. Among the many ideas the pathfinders must put to the test is what if any ideal shape their organisations will have. Should they align their boundaries with the local authority, or the acute trust or should it abandon conventional notions of neatly tessellated borders?

Some consortia are forming across two local authority areas or eschewing relationships with the local acute trust to join forces with a neighbouring trust – in one case across a county boundary. Others are challenging the notion that GPs must be organised in geographical clumps.

The south-west example illustrates that pathfinders are up for tackling difficult questions when it would be easier and more convenient to slip the organisational footprint into the departing PCT’s well-worn shoes.

At some point, well before April 2013, the experimentation will have to stop and then an interesting question arises. As Pulse notes, the health bill is clear that when pathfinders morph into consortia and acquire legal status, the puzzle will need to snap together to form a coherent and orderly picture.

The idea that this process will be self directing and that each of the experiments will result in the right pieces taking shape at just the right time does not seem credible. What will be the organising principle for redrawing the map if the map refuses to draw itself?