The Relationships Foundation has not been actively engaged in the current NHS reforms set out in the White Paper Equity and excellence: Liberating the NHS which will give groups of GPs rather than Primary Care Trusts responsibility for commissioning care for their local communities. When PCTS were being formed we worked with a number of them to assess the relationship implications. Our book “Relationships in the NHS” by Geoff Meads and John Ashcroft (available to download free here) set out many of the lessons. A subsequent book, “The Case for Interprofessional Collaboration in Health and Social Care“ looked at how collaborative relationships between professions, organisations, and with patients and communities is essential in both improving performance and reducing risk. This collaborative imperative will remain whatever form the commissioning process takes.
One of the lessons from the previous round of major organisational change was that the relationship implications were often inadequately considered and under-managed. Although individuals can sustain effective relationships in difficult contexts, leadership in the implementation of policy and organisational change is a critical factor in safeguarding the key relationships, insulating them from some of the destructive pressures. The attitude to change also matters: seeing it as an opportunity, rather than a threat, makes it more likely that the benefits of innovation will be realised.
The current reforms seek to bring commissioning closer to the patient, with more clinical influence on the decisions, and with greater flexibility and responsiveness in addressing patient needs. During previous reforms we explored different typologies of relationships for primary care groups and trusts, and it is likely that different relational dynamics will emerge this time. Modelling the different relationship styles, and understanding their various strengths and weaknesses, should be part of the implementation process. GPs will have to integrate the demands of relationships with individual patients, local communities, fellow GPs, other practice based medical staff, clinicians and managers in secondary care, as well as local social care providers. These demands are not new, but a key test of the reforms will be the extent to which they aid or hinder these relationships.