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All eyes on a long-term win

Dr Peter Ilves on how becoming clinical lead for his PBC group has meant recalibrating the pace of change

Dr Peter Ilves on how becoming clinical lead for his PBC group has meant recalibrating the pace of change

I fell into the post of clinical lead by a show of hands – mine was the only hand to go up in the room.

Eighteen months into the job, I now have a much truer perspective of what patients and people are asking for from their NHS.

Previously, I thought I knew best what my patients wanted and needed because I see them every day.

But being at the coalface you only get part of the picture and to truly commission on a scale that runs alongside the commissioning plans of a PCT requires wider vision.

In primary care we are used to looking at something, wanting to change it and making the change in a short space of time. Once meshed into the larger machine, one has to recalibrate the pace of change in our heads.

There has always been talk that PBC would and should deliver 80-90% of commissioning processes in years to come. But this assumed the PBC process would be transparent and that the skill base and resources to make it happen would be in place. In real life this has been much more difficult.

The NHS is a massive machine and PBC is front-ended by people who want things to happen fast.

Our Roehill PBC cluster was formed on the back of a split from our Putney neighbours. At the time this was peppered with a modicum of tension but it was rapidly evident that the split neatly divided two populations with a very different demographic.

Since the split it has been so much easier to concentrate on a certain population type and listen to consistent conversations from my colleagues in the newly formed cluster.

One significant confounding factor is the wonderful resource on our doorstep. Queen Mary's Hospital in Roehampton is right in the heart of our patch, in walking distance for more than half of our population. It is an interim care facility with the contents of a decent district general and we already work with Queen Mary's as if it is part of a federated polyclinic that we will be fine-tuning in the near future.

The cohesiveness of the cluster and shared goals has led us to work with several existing providers as if we had already commissioned the service. In doing this we have seen enhancements in our local radiology service, psychological therapies, and the musculoskeletal specialist physiotherapy service we have set up. However, we are most proud of the evolving relationship with our public health department.

If we are going to make some real changes, which are not strictly in the purest PBC fashion, public health are the people we need to work with. In a deprived, multicultural area with health indices that are very poor, the truly solid short-, medium- and long-term wins are going to be in the public health arena.

Winning small battles is great but being part of a larger, essential, long-term win is truly exciting.

There is a war to be fought out there that we all know about. In our small neck of the woods in RoeHill, we see the potential for change for a whole population with stark clarity now.

Dr Peter Ilves is clinical lead for Roehill PBC cluster and a singlehanded GP in Roehampton, south-west London

Dr Peter Ilves - If we are going to make some real changes public health are the people we need to work with Dr Peter Ilves - If we are going to make some real changes public health are the people we need to work with

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