May 2012
Whatever the consequences of the Health and Social Care Act turn
out to be, the inescapable conundrum facing the UK health system,
among many others, is the imperative at the very least to maintain,
and preferably to improve, standards of care and patient outcomes
in a chilly financial climate. Within this ‘quality agenda’ are a
number of still-unanswered questions about, among other things,
inequities in the provision of and access to primary care,
standards of nursing care and patient safety in hospitals,
population health inequalities related to deprivation and
exclusion, the morale and commitment of the NHS workforce, and the
future of professional education and training. This is, then, no
time to freeze in the headlights of reform and to give in to
planning blight as the bureaucracy is overhauled yet again. There
is, as Captain Jack Aubrey would undoubtedly have said were he in a
senior management role, no time to lose: ‘This ship, is England. So
it’s every hand to his rope or gun, quick’s the word and sharp’s
the action’.1
Which brings us neatly to the parallel challenge of leadership,
about which much is presently being written and that, as Veronica
Wilkie’s editorial explains, has now caught the attention of the
General Medical Council, whose recent document sets out a useful
framework describing what might be expected of doctors as leaders.
Of course, just as most clinicians won’t be heavily involved in
commissioning services within clinical commissioning groups, so
most will not take a lead in setting the course through these
troubled waters, if that isn’t straining the O’Brian metaphor too
much. Indeed, Sir Lewis Ritchie’s 2010 James Mackenzie Lecture on
the call of leadership2 employed images drawn from the
seafaring life of north-east Scotland. And, Andrew Moscrop argues,
any old leader won’t do — we need leaders with a moral compass,
attuned to the values and beliefs of those they lead, in contrast
to the ‘unsettling model’ of leadership adopted by the coalition
government over the NHS reforms. Quality and leadership are
intimately connected. One tells the other where we should be
heading and how we’ll know when we have arrived.
Quality measurement and quality assurance are major themes of
this issue of the BJGP. Mike Pringle’s clear exposition of the
relationships between performance, accountability, and quality
indicators sets the scene for the introduction — much trumpeted,
much delayed — of revalidation, the next quality assurance
mechanism, about which he is optimistic. Helen Lester and a number
of European colleagues report a valuable survey of practice
accreditation, another quality indicator, in over 20 countries, and
provide some useful pointers to the characteristics of effective
and accepted schemes. Jacqueline Hill’s paper from the Peninsula
Medical School is a welcome exploration of the potential of another
innovation — multisource feedback — in formative and summative
assessment, and in revalidation. This approach is well-established
in many professional and commercial settings and is likely to
become an important component of quality assurance in the future.
The quality theme runs through other papers on access, prescribing,
palliative care, and patients’ views of the Quality Outcomes
Framework — in which the surprise expressed by a patient on finding
that their GP was given an extra payment for taking their blood
pressure struck me as particularly salutary.
We have published and written a lot about the challenges of
making early and accurate diagnoses in primary care in the last
year or two, and have concentrated mostly on serious organic
disease and cancer. I think that a number of the studies we have
published will have a tangible benefit on diagnostic awareness and
precision. It was a pleasure, then, to have the opportunity to
publish Sara Ryan and Helen Salisbury’s important interview study —
’You know what boys are like’ — delineating some of the experiences
of the parents of children aged between 3–11 years diagnosed with
autistic spectrum conditions. Although their conclusions and
recommendations for primary care consist partly of generic advice
on good consulting practice, their emphasis on a very careful
exploration of the concerns and expectations of the parents of
these children cannot be overemphasised. Come to think of it, their
advice applies with considerable force to the interactional style
we ought to expect, but frequently do not receive, from our
political leaders.
Finally, we have to say a fond farewell to Professor David
Morrell, one of the great leaders and heroes of academic general
practice, who died in March, and whose obituary appears in RCGP
News, and a big welcome to Trish Greenhalgh, whose first column for
the BJGP ‘Outside the Box’ is published this month.
Roger Jones
Editor
References
1. O’Brian P. Master and commander. London: Collins, 1970.
2. Ritchie L. James Mackenzie Lecture 2010. Beyond the numbers game
— the call of leadership. Br J Gen Pract 2012; DOI:
10.3399/bjgp12X616472.
DOI: 10.3399/bjgp12X636272
To view the most recent issue, follow the links
below
> Members' login: for RCGP
members
> Logged in members: for those
already logged in
> Non-members: subscription
and Athens access
Would you like to discuss this article online? Join
the Discussion.
If you would like to subscribe to the BJGP, visit Subscribe.
To view other free articles, view Free content.