How advoates can improve clinical engagement, and why the veto on publishing the risk register is a threat to patient safety

Building bridges

Developing a constructive working relationship between senior managers and senior clinicians is a key aspiration for all healthcare organisations, whether private or public (interview, page 16, 10 May). But seeking to bridge the divide can often be daunting.

One practical approach to facilitate such “clinical engagement” is enlisting the help of a clinician to act as an advocate on behalf of the organisation. However, having undertaken this role over a number of years both within the NHS (as a medical director and as a public health consultant) and, more recently, for the private sector, I have learnt four key lessons:

  • Be sufficiently prepared. I have always found it more productive to have read up about the relevant clinical topic before embarking on any discussions. However a balance also needs to be struck between knowing enough but leaving room for debate, discussion and development.
  • Be clear about the aims, objectives and values of the organisation you are representing. More specifically discover what exactly they wish to achieve from any clinical engagement and, moreover, ask them to explicitly consider how other activities they are involved in might conflict with this.
  • Work to identify areas of common interest between the organisation and relevant clinical community. It might also be helpful to adjust the language used - for example, “value-based healthcare” (focusing on both costs and outcomes) is much more likely to generate clinical interest than “cost-conscious healthcare”.
  • Remain a member of the clinical community and continue to see patients. I would also suggest that practising as a generalist is ideal as it furnishes the “clinical facilitator” with a breadth of knowledge and an appreciation of their personal limitations. I also think specialists often view GPs like myself as individuals in urgent need of further education and, although an invitation to sit in a clinic might be made with this in mind, the opportunity to spend two hours with a specialist will always delivered broader dividends.

Dr Nick Summerton, GP, managing partner and NHS appraiser, private consultant, author and adviser, East Yorkshire

Risky business

The government’s decision to veto the publication of the risk register will do nothing to appease the unease of the NHS workforce over the potential pitfalls of reorganisation.

While ministers’ wishes to protect the quality of civil service advice is advisable, only by understanding what the risks are can problems be averted - and keeping the risk register confidential will do nothing to foster better understanding of the problems we must avoid.

This, sadly, is fast becoming the government’s modus operandi and has been seen repeatedly in other areas of policy, including the regulation of healthcare professionals such as clinical physiologists.

The government has repeatedly refused to consider the potential risks to patient care and safety of having unregulated - albeit highly trained and mostly highly professional - personnel performing complex and sensitive procedures directly on patients. Ministers have instead insisted upon a policy of wait and see by relying on ineffective and inefficient voluntary registers - and just as with the risk register have refused to look ahead at the possible pitfalls and deal with them accordingly.

If the government and Department of Health are effectively going to manage the transition to the new NHS, they should reverse the decision to withhold the risk register.  If they want to protect patient safety, they should think seriously about the statutory regulation of clinical physiologists.

Anne Burge, chair, Registration Council for Clinical Physiologists