Published: 06/05/2004, Volume II4, No. 5904 Page 25
Certain primary care trusts appear to be a little careless with their clinical professional staff. A quick review of the classifieds in the British Medical Journal or HSJ in the past year suggests that some primary care trust chief executives seem to change their employed professional medical, pharmaceutical and public health advisers more frequently than their socks. Similarly, the weekly GP press reports an increasing disengagement of clinicians from PCTs. Some doctors grumble that seeking their advice is essentially a cosmetic exercise.
One consultant even remarked to me that developing a business case is just a mechanism for a PCT to use to avoid supporting a clinical service.
Professional advisers are not easy to accommodate within a tightly managed healthcare organisation. There is often a dissonance: I have heard NHS managers use the terms 'disruptive' or 'difficult' to describe clinicians who are perceived by their peers as committed and caring.
If a PCT wishes to establish an enhanced service for anticoagulation in accordance with both the general medical services GP contract and the Building on the Best white paper on choice, an experienced GP who voiced concerns about the safety or efficacy of warfarin might appear to be acting against patient choice and modernisation.
Similarly, specialists who express concerns about the experience necessary to do the work they are involved in are not seeking to encourage 'restrictive practices', they are simply worried about patient safety.
On their part it is essential that professional advisers ensure they are up to the task.Having a medical degree or a certificate of completion of higher professional training does not necessarily qualify anyone to assume the role of a PCT medical adviser.An adviser should seek to combine their experience and expertise with a good understanding of the relevant policy and evidence. The aim should be to identify opportunities rather than barriers; it is a lot easier to be critical than constructively critical.
PCTs need to be much clearer about their professional advisory requirements. For example, some PCTs seeking to establish specialist roles in community-based cardiology are relying solely on advice from the local consultant cardiologist.Yet is this the best advice?
Hospital-based specialists may be more interested in extending the use of echocardiography into GP surgeries rather than, perhaps, improving primary prevention by focusing on assessment of cardiac risk and the recognition and management of hypertension.
PCT managers should not be shy of questioning advice or seeking additional advice. In the commercial sector, pharmaceutical executives have learned to take on board a range of professional advice, listen to it and subject the adviser to rigorous and intelligent interrogation.
Professional advice is essential to ensure that PCTs develop highquality clinical services.Although some advice may be uncomfortable and difficult to understand, PCT executives need to acquire the ability to accommodate and consider it, not simply to replace the adviser.
Nick Summerton is a GP and PCT research lead, and heads Hull University's public health and primary care division.