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Pandering to 'seat on the board' syndrome


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Thursday, 28 July 2011

Pandering to 'seat on the board' syndrome

GP commissioning was never the right name. It had three adverse affects on GPs themselves, reinforcing the belief that GPs know best, frightening the waverers who felt they were being committed to something they hadn’t signed up to, and confirming the suspicions of the anti-reformists that they were being set up for a fall.

The term GP commissioning had another powerfully negative effect. Although leading GPs were quick to point out that the reforms wouldn’t work unless GPs worked with their colleagues in hospitals, community services and local authorities, the suspicion remained that this was all about GPs.

The government clung pedantically to the technical argument that because the general practice list was the basic operating unit of the reforms, only a literal label would do.

It has taken a year to realise that “GP commissioning”, far from uniting clinical professionals behind the reforms, only succeeded in polarising them.

But in taking the sensible decision to rename GP commissioning consortia “clinical commissioning groups” the government also gave in to demands for wider representation. Now every CCG would need to make space at the board table for patients, nurses and secondary care clinicians.

Seat on the board syndrome (SOBS) is a condition that needs careful management.

Sufferers display symptoms including bossiness, paranoia, low self-esteem and the unshakeable conviction that the world would be a better place if they had a hand in running it. The ambition to sit on a board is almost always a disqualification for the job. 

Where practice-based commissioning worked well it already included consultants, nurses and allied health professionals. Left to their own devices, CCGs would have reached their own conclusions about who and how much to include from the world outside general practice.

Increasing representation at the top is not the answer. All that does is to create a system so overloaded with checks and balances that nothing works properly and everything slows down.

The challenge is to not to increase the franchise but to involve people more fully in change. Writing in the Guardian this week, Peter Samuel from the Nottingham University business school, uses the example of NHS Scotland, which has created what he calls “one of the biggest examples of industrial democracy in the world”.

The key ingredient he identifies is widespread partnership agreements between staff and management – boards are barely mentioned. The following paragraph sums it up.

“The enhanced participation of employees and their representatives, unions and professional associations, not only constrains management unilateralism: it grants them a vital say in important decisions affecting their working lives and, in this case, the quality of healthcare provision in Scotland.” 

The more representative CCG boards become the less accountable they will be and the less able to take decisions. Likewise the proliferation of bodies with a say in or a veto on local commissioning decisions is increasing at an alarming rate. Both of these developments may muffle the clamour for representation but neither will have any effect on the engagement of frontline staff or patients.

marieanneessam says:
Jul 29, 2011 07:48 AM
I agree the system yet again fosters polarity between those who, for optimal patient care, all need to be on "the same side". The challenge remains - can clinicians rise above that which leaves us competing and criticising, and unite with due intergrity to deliver patienr-centred excellence? When folks are voted onto booards, it is their wisdom, humility and team-skills which need as much consideration as their knowledge and decision-making. Healthcare is a vocation for a reason: now is the time for a new kind of collaborative leadership which overcomes destructive paranoia by simply upholding patient (not doctor) centred values
paulsmith3@nhs.net says:
Jul 29, 2011 09:07 AM
Where to begin? "because the general practice list was the basic operating unit of the reforms," lets not worry too much about that because the proposals to remove practice boundries will effectively destroy the value of a practice list.

"Where PBC worked well it already included etc etc" Again this change includes people from outside the immediate area - so how does that help in reforming one of the big bottle necks to service redesign - the hospital management keeping their budget intact?

Corporate memory? IMHO it does not exist in the 2/3 year job roundabout and over Bureaucratic development of the PCT which is leaving a defined stain on the new CCG (which probably are still the old PBC groups) of left overs from the centralist top down development of DH > SHA > PCT rule by fear syndrome
jpatterson says:
Jul 29, 2011 10:23 AM
Paul - We're not saying anything different. Before it given the QIPP treatment and reduced by 20% or so, the blog made exactly the same point about out of area consultants. It's window dressing. The idea that people will be fooled by this sham "representation" is laughable -- about as convincing as Robert Mugabe's election results.
rgjackson says:
Jul 29, 2011 11:27 AM
Could not agree more.What is wanted: an efficient body capable of seeking advice from subject matter experts and formulating a plan, or a "monkeys' parliament" where every man & his dog wants their 15 minutes of fame?
shoath2 says:
Aug 31, 2011 12:52 PM
Wonderful to see these issues so clearly expressed. The NHS's obsession with consensus and inclusion leads inexorably towards the meeting-heavy but decision-light culture we see in so many of the current structures and now being replicated in the new ones. We do not seem to learn either from our own experience or that of the real world. *sigh*