Editor Sue McNulty on how this month's edition mutated
So, tomorrow is my last press day deadline of 2010 and it's not been the easiest edition to put together.
The Focus On.. is ‘Breaking up the monopoly' – which looks at how commissioners can challenge the status quo of acute trusts being the top dogs on the providing block.
It was inspired, if you like, by a report from think tank Civitas a couple of months ago that highlighted how closed the NHS shop really was.
My working title for the Focus On was ‘tackling Goliath' and I'm a little red-faced about it now but one of the original features was going to be ‘Five ways to avoid acute trust gaming.' But as we started to ask the experts it became clear that like so many things in the NHS the dichotomy between acute trusts and commissioners was anything but black and white.
Trusts are under enormous pressure to make a profit and it's all very well saying "we'll send the private boys round" but what if private providers aren't on your patch yet? Or what if they go under in a couple of years' time?
Mature conversations need to take place between consortia and acute trusts.
If they're making a loss, you might need to get them to think like Railtrack and how they can open up their PFI hospital rooms to other providers.
The point I'm making is that this is not the hour for GPs to relish the chance to call the shots with consultants and tell acute trusts to up their game or hit the road.
Relationships are everything in business and should be no different in commissioning.
Rather it's time for really good clinical conversations to take place with consultants and to let the clinical quality aims dictate the route of direction – be that with the hospital as provider or an alternative provider.
I was at the NHS Alliance conference last week and two things stick in my mind. Firstly the comment by Dr David Morris a GP commissioner in Sandwell's comments that you need to ‘engage with grace' in dealing with your acute trust. Secondly, Dame Barbara Hakin's admission that she is ‘ashamed' now at how she and her colleagues dealt with their acute trust in Bradford back in the day.
‘We took stuff out of hospitals just because we could' she admitted.
And that was another message from the conference. That GPs want more help to become leaders and I think that's really encouraging – they realise there's an art to leadership and that they don't know it all yet.
