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The dangers of FUD poisoning


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Friday, 17 September 2010

The dangers of FUD poisoning

The computer industry, which was never short of an acronym, coined FUD -- for fear, uncertainty and doubt to describe the anxiety experienced by customers and stoked by suppliers.

The customer was faced with a choice: stick with the expensive, complex but flawed system already in place or go through a costly period of migration to another system, which might be better but involved considerable technical difficulty and business risk.

More often than not the FUD-weary customer stayed. Nobody ever got sacked for buying IBM, as the saying went. The parallels with the NHS are obvious, but the choice of migration to a new, complex and unproven system has already been made pending the outcome of the white paper consultation, of course.

The FUD continues to fly all the same. Every conversation about GP commissioning quickly becomes mired in detailed concerns, some of which remain, for the moment, unresolvable. How big or how small should consortia be? What is the appropriate organisational form? How and when should consortia think about federation? What happens to overspending or underperforming practices? What will be in the new GP contract? What incentives and rewards will be available to balance all the apparent risks and drawbacks?

GP commissioning raises so many questions it would be easy to get lost in a fog of unresolved issues and declare the whole enterprise simply too difficult.

GPs can be forgiven for worrying about the fine print of GP commissioning, but if we wait to answer every question and settle every issue well never get started. Talk to the PBC consortia who have achieved real change, better outcomes for patients, elimination of waste, productive relationships with the acute trust, community services or the local authority and the same two things emerge time and again.

First, they didn’t wait for certainty or permission or proof that it would work or for someone else to show the way. Second, the starting point is always the aspirations of the patient and their desire for a better experience of care, a more considerate, less wasteful NHS, a speedier recovery, a more effective treatment regime.

Patient centredness is not ideological but logical, because if whatever it is that you’re doing doesn’t work for the patient sitting across the desk from you, it wont work full stop.

This is why bottom up service design is more efficient you can see whether it will work sooner and avoid the waste of money and energy that comes from trying to do the wrong thing at scale.

The big computer system architecture of the 1970s would have continued to evolve at tectonic pace, but for a small discontinuity. The development of the microprocessor and the birth of the personal computer changed the industry and our lives for ever. It caused a redistribution of power enabled universal access to information.

The key word is personal. The microcomputer as it was called then allowed computing to happen at a scale that suddenly made sense to everyone.

GP commissioning holds out a similar promise of appropriate scale and personalisation. That's not to say that it doesn’t present a few challenges, but isn’t that what we signed up for?