Clinicians want the government to let them get on with 'doing the right thing for the patient'.

A Clinical Vision of a Reformed NHS, published by the NHS Confederation and the Joint Medical Consultative Committee calls on the government to be clearer on the direction of NHS policy - but step back from central diktat and target-setting.

It calls on ministers to move away from top-down direction and redress the 'loss of local autonomy' that has resulted from the way policy has been implemented and performance-managed.

Clinicians need to feel that they are working autonomously and are empowered to work professionally, creatively and innovatively at a local level to change the system, it says.

And it warns that a failure to create this change will have 'serious consequences' for the NHS and its patients. NHS Confederation policy director and report co-author Nigel Edwards told HSJ that this was because much of the change needed was 'in the hands of local clinicians and leaders'.

'Government can just as easily get in the way as help with change, it is now about changing how change-management works. It is more about the systems that are in place, about integration and about overcoming the primary and secondary care divide,' he said.

Mr Edwards said clinicians agreed that NHS middle managers had a 'tough job' and needed help and guidance to ensure that they were less 'risk averse'.

Picker Institute Europe chief executive Angela Coulter, who wrote a section of the report, said clinicians should be 'empowered to look for new ways to do things instead of battering them with central diktat, targets, and financial incentives, in order to liberate their creativity - professionalism is not dead'.

But Heart of England foundation trust chief executive Mark Goldman, a trained vascular surgeon, warned that clinicians would need to get used to a new NHS that was 'more challenging and less immediately rewarding'.

'Doctors need to step up to do clinical leadership but they need managers to support them and they need to work in a very sophisticated way,' he said.

For more analysis, read this week's feature on the report

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