Management in medicine

Sunday, 9 February 2014

There is no doubt that seeing and treating patients is the easy part of the job. It is also the most enjoyable and fulfilling part of the job and the bit that feels straight forward – after all, that is what all the training has been for. When I took over as clinical lead a couple of years ago I knew that there would be various challenges with senior colleagues retiring at the same time and re-organisation in the NHS. What I didn’t anticipate was this would involve bidding to run our current NHS service, at the same time as replacing consultants, managing an unexpected resignation, submitting business cases for new services, and managing the challenges of the new centralised booking hub and electronic patient record. It is no wonder that the escape to just seeing patients is so welcome.

Last year we knew that the new GP commissioning group in Brighton and Hove were looking to improve the current service for NHS patients requiring dermatology. For the last three years we have been involved in a pilot with a new community service which has operated in addition to the hospital service. What we collectively failed to achieve was a truly integrated service, which is not surprising with two organisations, different management structures, separate referral and triage pathways. The commissioners want to improve things and chose to put all dermatology outpatients services out for tender. This means any provider can submit a proposal to run the new service and is part of the government’s plan to increase competition and improve services.

We passed the initial pre-qualification stage at the end of last year with three other bidders. The intention to tender document was released in mid-January and we have just one week to complete our tender bid, with a few weeks of respite until we have to present our proposal and then a few more weeks of waiting to hear our fate. If we win, we can move forward with a new joined up service, which promises to improve the service we offer our patients. If we lose….. Losing is not an option!

Whilst all of this is hugely time consuming, mentally draining, and probably pushing me to the edge of what I can cope with, it is a real opportunity to look at how we run services, how we utilise our department and staff and to challenge ourselves with what we could do better. Improving one-stop-services and addressing the psychological needs of our patients is top of the commissioners want list. As a clinician it is high on our wish list too and it is achievable but requires investment and this is the potentially sticking point. The budget for the new service is fixed on what the commissioners currently spend. That means any provider will risk running a loss making service if it increases staff costs and yet without this investment the new provider will struggle to meet the service specifications. Welcome to the modern cash strapped NHS, focussed on making savings, whilst still trying to improve quality and efficiency!

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