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Because what’s the point of the NHS investing huge amounts of money in programmes that don’t support the values or the direction the organisation is going in?
Indeed! Please do not fool yourself that the NHS has any direction, it hasn't, and any values it had have been eroded over the last 10 years.
The new purpose of the NHS has to become a vehicle for satisfying patient demand, open all hours, staffed by people who do not have the clinical skills or resources to meet the public's expectations. This has been achieved by fragmentation of the service and dumbing down of front line staff, who are almost universally unsupported by so called managers who do not seem to understand that their prime purpose is to ensure efficient effective delivery of clinical services.
The splitting of the services into purchaser/provider arms has increased bureaucracy, depriving the NHS of resources to invest in clinical staff. This is of great benefit to senior managers who grow their empires while staying below the radar.
Primary care, and especialy primary clinicians, has been systematically disengaged from the decision making process, so, yes, it is extremely worrying that primary care is not represented in the top 250 initiative. Without a well organised and well resourced primary care, down stream costs will mount and mount, as we have already observed. David Nicholsons ramblings give me no confidence that he understands the NHS.