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I need a support-level integrated framework to decipher NHS management speak

I need a support-level integrated framework to decipher NHS management speak

Columnist Dr David Turner tries to make sense of what the NHS’s winter resilience plan actually says

I always thought I was pretty good at English, but recently I have started to think there must have been special English classes I was not privy to at school.

In fact, it seems like some students were singled out early on in their education and taught secret lessons in management speak. Because try as I might – and I have been trying for many years now – I can hardly make head or tail of any communication coming from an NHS manager.

Now, it is not so much that they seem to use 20 words where two would do, nor the fact that they favour the frequent use of unexplained acronyms to the extent that some sentences have more acronyms than words in them. No, it is more the case that as I read a piece of communication from an NHS management organisation, I just can’t shake off the feeling that I’m in some way being duped. What they are trying to say, which I suspect is of little consequence, is buried in a word salad of indecipherable gibberish.

A recent example is a letter from our ICB: ‘Working together [oh, yeah? Us at the coalface, you in the office, a long way from the frontline] to deliver a resilient winter.’

This three-page letter with an accompanying one-page appendix would do as a case study for a master class in management speak; a textbook example of how to say as little as possible using the most words.

Some sentences that leap out include: ‘One of the key recommendations from the Fuller report was to develop a single system-wide approach to managing integrated urgent care to guarantee same-day care for patients and a more sustainable model for practices…’

I don’t really follow, but I think it’s saying: ‘Work harder and see everyone who wants to be seen on the day they want to be seen.’ And it paradoxically suggests this will make general practice more sustainable.

Then, from the contradictory to the insultingly obvious, another gem of wisdom states: ‘To maximise the funding available, PCNs should also consider how existing and additional appointed workforce for winter support the winter demands.’ Thanks for that advice, as our PCN was just about to blow a ton of money on some experts in tropical diseases to help us out over the winter.

The appendix lists a number of bulletpoints, most of which are too turgid to dissect. What did stand out, though, was: ‘Work with the ICB to develop system plans and communication strategies to maximise the role of general practice…’ But I struggle to think how we could maximise our role any more unless we open a tanning parlour and a nail bar in the waiting room.

Another sentence simply states: ‘Implementing modern general practice.‘ Yet, I’m confused by this. Do they mean that we should no longer be using leeches and mercury salts to treat patients, or are they suggesting that we get new computers?

However, I think this final sentence takes the whole packet of digestives: ‘Understanding general practice transformation maturity and support needs, via completion of the support level framework to enable ongoing local support to continue improvement.’ To think I used to find Chaucer challenging.

I think what they are trying to say in this letter is: ‘You will have to work even harder with what you have, and you are not getting any more.’ There, I could have saved them a bit of money on typing.

Dr David Turner is a GP in Hertfordshire. Read more of his blogs here



Please note, only GPs are permitted to add comments to articles

Sam Macphie 15 September, 2023 2:40 pm

You are absolutely correct Dr Turner. This seems to be the raison d’etre of NHSE, CEOs and other managers who earn much more than a gp. It’s political speak and a contrivance of bamboozlement to justify their huge salaries that might be better spent elsewhere in the NHS. If some of these people were to become proper communicators, this should be outlawed and GPs would not need to waste their precious time trying to interpret management political speak: this can sometimes make you think they say one thing when in fact it can mean something opposite. Are these high-earning managers using this language tongue-in-cheek sometimes do you think? Or trying to impress by hoaxing, cheating and mystifying others (and each other), who knows?
What is the point when few GPs can understand the exact meaning of what these people are saying. Perhaps Mandy Preachard, Chief Executive of NHSEngland, should send out a memo, email to all involved who use this type of nonsense jargon. Terrible.

Janine O'Kane 15 September, 2023 4:45 pm

I used to ask our practice manager to translate the letters into English for me !

Dylan Summers 23 September, 2023 1:24 pm

The medical profession is hardly blameless here.

We could tell patients that their spinal cord comes “through the big hole”, but instead we say “through the foramen magnum”.

And we rarely refer to the “flat bit” in the eye, but that’s all that “pars plana” means.

Doctors were specialising in linguistic obscurity long before the management consultants!

Dylan Summers 23 September, 2023 1:27 pm

(OK I’m not being fair here. Doctors use Latin terms to avoid ambiguity. Dr Turner’s examples seem designed to create unnecessary ambiguity)

Dr No 26 September, 2023 11:45 pm

Well here’s a a plain speaking version of a common euphemism. The Tory Party = Neo Nazi Scumbags. With reference to Swella