Kathy McLean: Your views on clinical networks, midwifery and diagnostics

Dr Kathy McLeanI’m delighted to have received some responses to my earlier posts. There are quite a variety of comments, and some more questions too.

Here are some further thoughts and responses from me:

1. To clarify; the concern I have heard about secondary care (which I wrote about here) is how do both primary care clinicians and specialists/secondary care clinicians design pathways that influence the commissioners to commission them?
I’m really keen to hear your ideas about how to facilitate this. Are there issues which prevent it from happening? What role do you think clinical networks could/should have in this?

2. The listening exercise is now developing and I am looking forward to meeting more people over the next few weeks in order to hear concerns and also suggestions which I can then share with other groups.

3. Some of you have raised issues about diagnostics and I would extend that to scientists and others. I am still keen to hear about any other groups who may not have been mentioned so far.
Who do you think is missing or could be better represented?

4. @Jessica raised the issue of midwifery representation in response to this post. This point is one I have also heard from others and will take note of.

The listening exercise is helping me to develop my thinking as we go along. All your posts are really helpful so please keep contributing to the exercise.

Dr Kathy McLean

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3 Responses to Kathy McLean: Your views on clinical networks, midwifery and diagnostics

  1. Sarah Saul says:

    we were locked in a room with secondary care consultants when we were creating our vertically integrated musculoskeletal physiotherapy pathway which involves clinical assessment triage, assessment, referral for diagnostics, work up to secondary care, virtual clinics with secondary care-ensuring only the ones who need to get seen in secondary care.
    locked in, 5 hours of post its, flow diagrams, transformational work , one lead, strong commissioning, dynamic leader, change agent philosophy all helped.
    really want to get involved-make a difference, do a blog, aid in transformation, change, support the NHS reforms especially after the publication in the mail of all the wastage on luxury cars and team events within SHA’s-I’d only need a 1ooth of that money and we could avoid losing staff on maternity leave etc and not getting posts filled….would really like to help.
    Sarah Saul
    Business Manager
    CCS NHS Trust

  2. Rod Whiteley says:

    As I see it, commissioners and providers need to have a shared view of the clinical outcomes being achieved, and commissioners should be open about the priority areas where they feel local provision is lacking. Then clinicians will know exactly what’s likely to succeed when designing new provision, including new pathways.

    In the one piece of commissioning I’ve seen close up, the PCT’s goals seem to have been financial rather than clinical, the whole process has been opaque, and clinical outcomes seem to have been deliberately excluded from consideration. I suspect this was because the PCT saw itself as both commissioner and provider, designing the service itself behind closed doors and then outsourcing service delivery (to the private sector, as it happens).

    I would say the issues that prevented clinicians from taking the lead in this case were lack of transparency by the PCT, and the focus on cost as opposed to quality.

  3. Marcia Reid says:

    Effective pathway mapping is key to the success of any commissioning project. My concern is the emphasis on primary care in the process. Key stakeholders from every stage of the pathway should be consulted and consensus reached. I have facilitated many such processes, always resulting in agreement, often after heated debate. Strong, independent and informed facilitation must be included to avoid primary care bias. I was horrified at the NHS Expo event to hear a GP consortia boasting that the ‘quick wins’ they had made in service delivery led to improving equipment at their surgery. The hospitals must be consulted at every stage of the process and treated with equal respect to community care delivery agencies.

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