The NHS Confederation and Joint Medical Consultative Council have unveiled a new report that sets out a “clinical vision of a reformed National Health Service”.

The NHS is struggling to keep up with a series of wide-ranging reforms set by the government, such as the implementation of practice-based commissioning and the new 18-week target. The NHS Confederation has long argued that frontline staff are often unsure of what the reforms are trying to achieve, while clinicians have voiced concern that they have not played a big enough hand in their design.

Last year, the Confederation, which represents senior managers in the Service, and the JMCC, representing clinicians, decided it was time to “shift the debate from a critique of the reforms to a more positive vision for a reformed system”, and asked doctors “what it would be like to practise in a reformed NHS that was based on their own vision or experience of creating change themselves”.

Drawing on the doctors’ responses, the groups then identified a number of issues standing in the way of service improvement, and made a number of recommendations for providing a basis for a high-quality service, including:

- Getting the basics right. This is essential, it says, as no matter how good the clinical result, a patient’s experience of visiting a hospital can be ruined by poor administration, impoliteness, or an unpleasant environment;

- Involving doctors. The research underscores that doctors have often felt in the past that they have not been properly involved in developing reform policies in the NHS, and cites examples such as the fiasco surrounding the failed medical training application service for recruiting junior doctors, and the electronic patient record. And, in return for better involvement, clinicians should emphasise a positive way forward rather than focusing on current faults, it advises;

- Doctors as national clinical leaders. Through secondments, senior doctors should have roles in policy making or regulatory bodies such as the Department of Health and the Healthcare Commission, in order to make the most of their input;

- Shared values. Clinicians see their role as part of a system that links in colleagues and other services. Underpinning the idea of health services as a system should be shared values, and time and effort must be spent articulating what these values are with quality of care for patients at the core;

- Better quality data. The NHS needs to make sure that the correct data is measured so that a truly patient focused service is created. As shown by the cardiac and intensive care audit, the quality of this data will be much better if clinicians take responsibility for collecting it; and

- Addressing complaints. The report found that many doctors have clearly become frustrated working within the NHS, and says that addressing this frustration is central to its future vision. But it points out that some interviewees felt that some criticism went so far as to be unprofessional, and should be challenged.

Local responsibility for change

The JMCC and NHS Confederation believe there are clear actions for government, particularly on the process of involving doctors where a significant change of approach is needed, and they stress that policy must not make it hard to do the right thing for the patient. But, they add, it is in the hands of clinicians and managers to create change in their own organisations, and warn a failure to do so will leave serious consequences for the NHS and its patients.

“There is clearly great potential in getting clinicians to help to create a better, more efficient health service that is able to innovate and fully meet the needs of patients,” commented NHS Confederation director of policy, and co-author of the report, Nigel Edwards. There has rarely been a better opportunity for clinicians to show leadership in today's NHS,” he claimed.

And Professor Bill Dunlop, chair of the Joint Consultative Medical Council and co-author of the report, added: "Our report found that many doctors have themselves initiated change and developed innovative solutions locally. Clinicians want to work in partnership with their NHS trust managers to design better services for patients and to be freed from the policy constraints which so often interfere with their desire to innovate and improve patient care.”

“There is a high level of commitment and dedication among NHS doctors and these professional values should be harnessed to further enhance care for patients,” he concluded.