Every day, thousands of people working in the health centres, clinics, GP practices, hospitals, prisons, police stations, the Services, research labs, deal with an array of pathways, systems and organisations that highlight an issue that only those of us working in and sometimes alongside the NHS can change – our relationships with each other.
The reasons to enter the world of medicine are different for everyone, but it’s reasonable to assume that for all of us, the aim of ‘making people better’ is a common desire for all doctors. Certainly, the comments of doctors recently promoted in a social media campaign run by NHS England to recognise the work of primary care in London, express the significant rewards of helping to improve peoples’ lives.
Sadly, there is an uncomfortable truth about the relationships doctors have with each other that begins in the training process, which historically has not focussed on team work as a priority. As a GP, I have many excellent relationships with fellow doctors working in primary, secondary and mental health care, and other places, that helps me to provide the sort of care my patients need.
When the communication between doctors works, it makes a tremendous difference to the quality of care we provide and our job satisfaction – and when it doesn’t, everyone is affected, especially our patients and their families. The stories of inappropriate referrals, lack of follow-up, ‘lost’ test results, duplication or omission, come from all doctors, wherever they are based. We blame ‘the system’ and ‘managers’ but we can change that if we want.
We cannot continue to carefully plan care pathways that look good on paper but don’t work because individuals have not ’bought into’ the changes. We cannot claim ‘the system’ doesn’t work when we’ as part of ‘the system’’ are not doing everything we can to make it work.
At the best of times, consultants and GPs work closely together to manage care using processes and systems they have designed themselves and that come from culturally feasible ways of working, grounded in the views of patients, service users, carers, and staff. This ‘bottom-up’ approach, which needs to happen across all services, must start with early, honest and open conversations between the doctors – wherever they are – to ensure that the strategies driving the allocation and planning of resources work in the real world. Doctors need to provide the kinds of solutions that can grow to meet the needs of local populations – and to achieve that we need to understand each other.
Doctors need to talk to doctors.
Dr Marc Rowland
Chair London Clinical Commissioning Council
and NHS Lewisham Clinical Commissioning Group