Health and Social Care

Doctors and clinicians at the heart of integration

February 17, 2015 by No Comments | Category Uncategorized

Engagement of clinicians and more specifically doctors, is vital to the success of the new integration arrangements.  We cannot afford for the new partnerships to fail in the same way as their predecessor organisations – Community Health Partnerships (CHPs) did, so we must make sure that those issues that disenfranchised doctors encountered are not repeated.

GPs told us that CHPs had no real influence, they were viewed as local groups delivering ‘top-down’ priorities of the NHS Board.  There was no genuine interest or attempt to shape service delivery from the ‘bottom-up’.  So the new Integration Authorities must be guided and led by locality groups that have the financial influence and power to affect change.

GPs also told us that meetings were management driven, with little consideration or interest in clinical perspectives.  These groups – originally intended to be clinically driven and management supported, had instead become management structures.  Many felt that time spent in long, bureaucratic meetings was time that could be better spent seeing and treating patients, or catching up on the ever increasing piles of paperwork.

What about hospital doctors?  Well they haven’t really had to get too closely involved in integration as secondary care has always remained outside of the remit of efforts to integrate care.  But now that budgets and services are to form part of the integration schemes we need to find new ways to reach those involved in the delivery of services to patients in newly integrated services, particularly those working in hospitals.

So in the new world of integration what would engage doctors?  Primarily, a view that these new bodies have genuine influence over the planning and delivery of services.  But like all professionals, doctors are facing ever increasing demands on their time. They need to feel that time spent away from patients is time well spent and is worthwhile from a clinical perspective. They also need plenty of notice to attend meetings as reorganising clinic rotas or finding a GP locum is not an easy or quick process.

A lot of the debate has focused on closer working in communities between primary care health services and local social care services, but doctors can see a huge potential benefit of improving the interface between primary and secondary care health services. It is vital that we don’t miss this opportunity to blur the boundaries between hospital and community based care as we go forward.

We also look forward to having a say on the statutory guidance that’s being developed on localities. Hopefully this will provide a better articulation of the principles and ethos of localities and what this will actually mean in practice.

For more information on the role of BMA Scotland in integration, contact Gail Grant.

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