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The need for leaders with clinical credibility

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Communications and engagement manager Martin Machray considers the need for clinical staff to be at the centre of the changes heralded by the white paper.

One of my reasons for returning to practice has been a desire to re-establish my clinical credibility at a time when government policy makes great play of clinical leadership in the brave new, post white paper world. Of course, within the cloistered world of PCTs there is huge interest in the transition form the old to the new. Not just because jobs are on the line but because there is a genuine desire to reduce the turmoil that could ensue from the biggest reorganisation of the NHS I have ever experienced (and I’ve been through a few in the last quarter of a century). I therefore expected to see the same level of interest or concern among those in clinical practice.

At this point I can now mentally picture nurses up and down the country raising their eyebrows in a cynical response to another out of touch manager who in their view is completely detached from the real world of patients and wards, clinics and care. More changes to management must seem like rearranging the seating arrangements on the doomed cruise liner. Yes, lots of staff are interested in the changes but it would seem from the rather detached perspective of the onlooker. If you’re in a hospital scurrying for foundation status it may be different, but working within primary care it would seem like the change is happening around us rather than involving us. Yet aren’t clinical staff supposed to be at the centre of these changes?

Of course I am misusing the word clinical in this instance. What the secretary of state means when he talks about clinicians is GPs. There have been some soft soap words to other professions since the publication of the white paper in July but it is still obviously going to be a GP-led health system if the vision of the coalition becomes reality. The RCN and others have pointed out the weaknesses inherent in this but the result at grass roots seems to be, at best, resigned disinterest. However, at the same time, we know what the longer term result of this could be. Give one particular interest group, in this case GPs, 80% of the budget to spend and other professions, including ours, will experience a disproportionate and negative impact. District nursing, health visiting, specialist nursing advice all might seem like expensive extras to general practitioners making all the commissioning decisions on behalf of their patients. Not a formula for quality patient care. However, more than once I’ve heard nurses say things like “it really won’t affect us” and “it’s just another set of changes happening above me”.

What’s more, it would seem that the same reaction is generated in discussion about the spending review and financial cuts. The media have repeatedly reported the misconception that health has been spared the worst of it and this is repeated within our ranks. £15-20bn of cuts over the next three years doesn’t feel like the axe has missed us! I’m not certain if this sense of ennui is actually a sensible response to political noise or a short sighted approach that will mean we are disenfranchised in the future?

I joined a commissioning organisation because I wanted to make a positive difference to my community as a whole and I am returning to practice in the hope that I can influence the future of commissioning too. Will I or other nurses get that chance?

About the author

Martin Machray is a health service communications and engagement manager for NHS Islington. He began his career as a student nurse in the 1980s and was involved in frontline care nursing for a number of years until he moved into senior nursing management. From here he entered strategic and operational management posts, both in hospital environments and in national organisations before assuming his current role.


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