Imagine an organisation. It’s not small – in fact it’s large enough to require local and national offices. Like any big organisation, decisions are made at national level, and shared (or cascaded, to use the right lingo), down to those on the ground.
It would be comical if we weren’t dealing with people’s lives.
This isn’t a novel type of organisational set-up, it works across the globe in all manner of settings. Sometimes – just to mix things up a bit – those at the top decide it would be cheaper to outsource the local stuff. Maybe to a private company with its eye on the long game – that always makes it more interesting. They promise to modernise, revamp and transform. Slick infographics appear in glossy brochures. The national bosses nod sagely. Words like ‘innovative’ are bandied about.
The decree comes down and change happens, often with little warning. Except – shock, horror – it’s not as straightforward as expected. The clever bosses can’t seem to control the local contractor. Concerned emails are sent – meeting face to face is so passé. Strongly worded letters are written. But the problem persists.
Months go by. The missives from above don’t seem to reach the local outsourced offices. The bosses shake their heads and talk about mistakes being made. Meanwhile, the minions toil on and nothing ever gets fixed. The local contractor never gets punished or has its funding reduced. No one ever carries the can.
Yes, I’m talking about the NHS. It would be comical if we weren’t dealing with people’s lives. It is sobering, when someone comes in from another industry, to witness their incredulity at the havoc that springs from the many contracts, outsourcing and procurements that feed off the NHS.
From appraisal and resilience funding, to estates and premises. From pensions cheques and performers lists to antiviral prescribing and pregabalin. The monster that is top-down communication stalks GPs’ every move.
If your receptionist was employed to answer the phones, but spent all day staring at the fax machine, would you send a concerned email? No. You’d get out her job description and ask what was going on. If your nurse was employed to give vaccinations, but decided to take blood samples instead, would you sigh ruefully and let her carry on for another six months? No.
If your practice manager decided keeping funds in the bank wasn’t the way to go and invested in a racehorse instead, would you stand by and hope she’d get it right in time? Of course not.
If we showed such a lack of leadership and accountability in our own small businesses, we’d be marked down by the CQC before you could say ‘Jeremy Hunt’.
The modern NHS encourages us all to take a customer-focused approach. The irony is astonishing, when we are hampered by such abysmal support structures, with no clear lines of communication. The words ‘piss-up’ and ‘brewery’ spring to mind.
How about this for a novel idea: if it ain’t broke, don’t fix it. And if it is broke, because of a short-sighted, money-saving procurement process, then damn well sort it out. And never repeat the mistake again.
Dr Zoe Norris is a GP in Hull. You can follow her on Twitter @dr_zo