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Engaging clinicians is pivotal to NHS transformation

As the NHS publishes its long-awaited ten year plan, MV consultant Umar Majid argues that change is only possible with the support and buy-in of clinical staff.

The NHS is changing and it is clinicians who hold the key to ensuring that this change is successful and sustainable.

As patients’ needs are becoming more complex, the population is ageing, and financial pressures are greater than ever before, complex transformation projects are happening all across the NHS. A shift to Integrated Care Systems, moving care into the community, and the application of new technologies, for example, all aim to improve services for patients and make them more efficient. For any of these projects to be successful, my experience has taught me that securing clinical engagement is vital.

Why are clinicians important to change?

Clinicians see patient after patient. They are the most crucial component of delivering a high quality service to patients. Not only do clinicians have an understanding of how services need to be changed to best support patients, but also what support is needed in delivering the care itself. They provide critical insight to guide the reconfiguration of services in the most appropriate way, whilst ensuring any transformational change remains safe for patients.

Before joining Mutual Ventures, I was involved with a range of large-scale transform projects in the NHS. All of these required considerable changes in both staff behaviour and how patients interact with services. As the experts in care, change couldn’t happen without the support of clinical staff. For example, at NHS England, I was involved in a major project to change how foot care services were delivered across London. The aim of the work was to improve the patient ‘pathways’ and prevent people arriving in hospital with late stage foot disease, resulting in amputations.

From the outset of the project, GPs, consultants, nurses and podiatrists were involved, alongside patients, service managers and commissioners. Through engagement with these groups of clinicians, we were able to identify the gaps in patients’ and clinicians’ knowledge and learning and why the current referral pathways were not effective. Workshops identified ‘pinch points’ and weaknesses, including where podiatrists felt they were under-used in the current service. With clinical oversight, we were able to create training materials and redesign the pathways to ensure more effective clinical contact at each stage. This resulted in quicker and better quality referrals to hospitals and community services.

With a range of clinicians involved, they became advocates for changes and went on to support their peers locally with putting those changes into practice. Their involvement generated momentum across the project and helped to win over sceptics.

Without clinical engagement, the contrast in outcomes was marked. In one CCG, we lacked GP involvement in the project. This meant that many of the changes we made were not adopted and, as a result, pathways continued to be ineffective. Across the project, the general finding was that those areas with less extensive clinical engagement were most likely to have teething problems.

What can we learn from this?

The NHS has just published its ten-year plan, which will inevitably involve more ambitious transformational projects. I have learnt that involving clinicians needs to be at the heart of every change and that, without this, change will fail.

Overall, clinical engagement in transformation needs to become second nature and part of the NHS’s ‘business as usual’. This shouldn’t be a choice – the NHS needs to understand that transformation is necessary and, simply put, coupling change with clinical input is the sensible way of going about it.

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