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From gamekeeper to poacher – I’m off to work for the local trust

Do you remember being a house-officer? Or, if you’re very young, an FY1? At the end of one six month hospital post you finish a medical post on Friday evening and go to work at a surgical one on Monday morning. In the blink of an eye you change wards, colleagues, patients, bosses and often hospitals. In my training I did this nine times and it becomes a way of life.

Now I’m changing jobs again, not my GP role which remains the constant background it has been for nigh on 30 years, but my other life in management, in health services commissioning. I am going from what many of my colleagues regard as the dark side, working as a commissioner for CCG central, to what my CCG pals regard as a darker side still. I’m going to a management role within a rufty-tufty acute trust. Metaphorically, indeed physically, I’m going to sit on the other side of the table. Gamekeeper turned poacher, having spent six years trying to alter trusts’ performance through the dark, but necessarily distant, art, of contract negotiation, capping, block-contracting, CQUINing and the rest to get the best care for our patients from a finite resources pot.

I’m going to be on the other side with new colleagues who, no doubt, will cheerfully say to me, “you’ve spent years asking us for more care for less resource, to go faster, better, safer, friendlier now let’s see you do it”. One thing I have learnt chairing the contract committee is that in commissioning healthcare the contract may be the legal document both parties sign but it is worthless in terms of patient care unless you have the relationships right.

Now, unlike the houseman’s tale, I do not start work on Monday having finished on Friday – my PCT contract to work for my CCG as a commissioner has a three month notice clause. By joint agreement, thank goodness, this is going to be shortened to a month which is great because right now I feel like I’m in the scene at the end of Butch Cassidy and the Sundance Kid where they burst out to take on the Bolivian army, freeze, turn to sepia and fade into history. I’m chomping at the bit for the new role but, because we have made our health service a market worth billions, my usefulness to CCG central is hobbled by commercial sensitivities. My time in limbo is limited but brings me to a final point I would like you to consider.

Please, please spare a thought for the countless thousands of dedicated NHS staff from PAs and secretaries to data clerks and IT experts to public health consultants and senior managers who are currently in that same limbo as me. The difference is they are not there through choice or experiencing the excitement of a new challenge but as a consequence of major structural change in the NHS which brings with it dislocation, planning blight, loss of organisational memory and very real personal pain not to mention stressful uncertainty about employment. I support the premise of clinical involvement in commissioning healthcare but do we really need the major NHS restructure to get there?