Service delivery

my major concern relates to what I call parallelism in the management structure of secondary care. As a senior consultant I have the traditional responsibility for patient care that I have always had but now I have no power to make things happen for my patients. That has been devolved to the parallel management structures of management itself and nursing with medical influence taking third place to these two. Strategic decisions are made on the basis of government targets and protocol driven care without reference to the clinical experience. I feel helpless and disconnected from the services that nominally at least I am responsible for. Surely I am not the only consultant in this situation!

There needs to be more investment in IT in both primary and secondary care. However, the centralisation of projects will fail as it has done in the past. Better to have a series of interoperability standards to allow differing systems to communicate reliably.

In response to davids: I think most consultants share your experience. In my view, a significant reason for this marginalisation of doctors from decision making is our general reluctance to put ourselves forward for management positions. Clinical director posts have always seemed very unattractive to me - the real danger is of being caught between the wishes of your clinical colleagues and the instructions of your superiors in management, while having insufficient time and resources to perform the role well.

I quite agree that applying for clinical director posts does not seem an attractive option, due to unreasonable expectations from business management teams with insufficient resources to be able to carry out the role effectively. Employers need to recognise that the benefits of enagagement with clinical staff can only be achieved if appropriately resourced. Maybe the BMJ Leraning Leadership modules, or the new Faculty of Medical Leadership and Management, can both assist with providing resources for those who do undertake such roles.

I have always admired the Mayo Clinic concept in the USA and I would like to see the development of a similar Institute in the UK where patients with baffling symptomatology can be referred. This development would mesh with the rare disease recognition initiative and would provide a centre of excellence for clinical and investigative research. Dr Philip Roberts. Norwich.

In response to drbrown1970, we have some experience in Lincolnshire working with shared IT systems between Primary & Secondary Care. Whilst there are certain major advantages, especially in terms of seeing what colleagues have written and what is happening to our patients in real time, there are major costs in terms of swathes of redundant codes and incorrect data issues which have arisen. Training is crucial, and sadly our colleagues in Community Nursing just haven't had it.

integration is helped by common / sharable data, but the core to delivery is autonomous teams able to cross refer! that means either common management, or administration which supports referrals... that should be the goal of CCG's in england. john

The gap between IT aspirations (iPad in hand which can access all the patient's data and also allow you to illustrate your treatment plan) and IT reality (6kg of disintegrating paper notes and no more free pens from Big Pharma) has never seemed wider. Whatever happened to Tomorrow's World?

Gosh. My thoughts are perhaps rather less technological or managerial. I fought a long and for a long time lonely campaign (as the only local consultant prepared to speak out pubicly) questioning the rationale for reconfiguring our local maternity and special care baby services to greatly reduce them at one local hospital. GPs and the public supported me. Ultimately we were successful. I think that some reconfiguration in some places is needed, and there are definitely some services where bigger is better in secondary carte, and some places/services where more can be done locally. But I am very concerned about the twin mantras of "delivering care closer to home" and centralisation of hospital services. I think many of our local hospitals and many of their services still have a real and good role to play, in liaison with local GPs and tertiary specialists.

In my view a significant reason for this marginalization of doctors from decision making is our general reluctance to put ourselves forward for management positions <a href=”http://www.how-to-lose-belly-fat-fast.net/”>how to lose belly fat fast</a>