'Fitness for purpose has given us intelligence, new understandings and insights into the changing role of being a fully fledged commissioner in the new NHS. It has.helped us respond to the new realities and changes that have taken place in our relationships in and outside the NHS'

I've heard it said that Americans set great store by results, Europeans by process.

The trick with fitness for purpose is to turn process into results. Then, as the management gurus say: 'Turn good into great.' That takes care of.the bit from the official manual, but what about the practicalities, not to mention the timing of the whole exercise?

Well, we all have our goals, targets and a sense of purpose. The trick is achieving them all - and that is.where the fitness for purpose process plays its part.

OK, so it might have been the last thing we wanted, coming as it did just after primary care trust.reform, just as we were all getting to grips with new realities, new staff, new and often merged territories, with all the resulting 'two into one doesn't always go' scenarios.

Small can be beautiful

Even so, we all managed to somehow cope in the short-term and in the long-term the fitness for purpose exercise has proved to be of value. It has helped us to tease out issues and areas where strategies and practices were not as integrated or robust as we might have liked them to be. It has.helped us readdress some of the key issues, such as health inequalities, in a far more focused way. And if we are.to turn our own strategic health authority's Living Longer, Living Better, Caring More policy into something more than a slogan or a declaration of intent, that is.all to the good.

The results of our fitness for purpose exercise have given us a boost in a non-threatening way, with the advantage of expert advice from management consultants, and from our colleagues in other NHS trusts who took part in the process as our peer reviewers. Like all external advice, it has provided microscopic analysis but with an IMAX-wide panoramic view. Small can be beautiful, especially when looking at the bigger picture.

Fitness for purpose has given us intelligence, new understandings and insights into the changing role of being a fully fledged commissioner in the new NHS. It has.helped us respond to the new realities and the changes that have taken place in our relationships in and outside the NHS. We also had a board-to-board meeting with our SHA to learn the results, and that was in itself highly useful.

New realities
The spin-offs have been helpful, too. In hindsight, the process has helped us hone a new set of skills based around managing the market, new processes for self-assessment, and for implementing our development plans. It has.also given a boost to the process of empowering staff, and our roadmap is now designed to help us respond better to the changing NHS, which is a complex arrangement of differing bodies and services, bound by increasing public expectations.

If we are.honest, I suppose most of us welcomed the process as a real pain in the proverbial. Nine months on, it doesn't seem so bad at all. We have.all readjusted to the new realities, and we are.all getting on with the job in hand. My directors tell me that they think the new hymn sheet is now clearly recognisable to all of.the newly assembled and newly participating congregation and that we are.all reading from it together.

Do I hear a faint chorus of approval? Or am I just an incorrigible optimist?