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Dragons befriend villagers over commissioning

Last week, Hospital Dr published a news story about consultants being left out of new GP commissioning arrangements. Dr Partha Kar, consultant in diabetes and endocrinology, Portsmouth Hospitals NHS Trust, tweeted that this was a sweeping statement and not the case everywhere. He wrote the following about his personal experiences of developing a more integrated approach to delivering diabetes services. A longer version is posted on his blog here.

Today I am in the mood to tell a story. Once upon a time, in a far away land called Pompeyshire, there used to live a posse of big bad dragons (also called consultants).

In the villages, the commoners – or GPs – used to live in fear of the dragons, who used to scare them into sending gifts called patients to the castle in which the dragons lived.

The dragons grew stronger, they had all the wealth and the villagers were cowed down, wondering when their shining knight would arrive. And then they did: they were called PCTs and commissioners.

They started to stop sending gifts and the dragons started to snap and snarl. The impasse grew and then, one day, the unthinkable happened. The commoners became the knights themselves, they had access to shiny weapons and throughout the land of Britain, it was clear that the end of the dragons were nigh.

The dragons were after all beasts to be feared – the myth was strong, they belched fire, and chomped on the gifts offered slowly. The mob bayed for their blood, but then a small child squeaked: “But I haven’t seen any dragon, mummy, have you?”

Throughout the swirling crowds, the whispers spread like wildfire. Surely someone had seen these mystical creatures? They’re horrible, arrogant, fire spewing obnoxious beasts – someone must have seen them? But it slowly dawned that no one had actually seen one.

The dragons sulked in their castles. They felt powerless and hurt. Hurt at being left out, hurt at being ignored. They thought they had been trying to help. They’d looked after all those gifts the villagers had sent them and tried to make things better for everybody. So, what had happened? Just because they hadn’t wanted to speak to the villagers when they had the powers, surely that didn’t mean they should be left out now, should it?

Eventually the dragons got together and hatched a nefarious plot to steal back the higher ground. There was the Professorax (sorry if I mix my dragons with dinosaurs) sage-like, nodding at suggestions while chewing on his favourite diet…lipids. There was Iainosaurus who put forward lots of questions but kept playing with his gadgets and regularly turned up late for the meetings. Darrylex: prone to erupting at the incompetence of the system but happy to calm down once given a few feet to chomp on; and then, there was Karosauros – the young buck who thought he had the answer to everything while the rest just wanted him to get a haircut.

But between them, those dinos were clever. They thought of something incredibly dastardly, something that would make young readers’ blood curdle; they decided…here it comes…to join the villagers!

Karosauros was sent out to meet the villagers. The villagers were cautious but then it was discovered that the dinos and the villagers could actually live together. The gifts they had sent to the castle hadn’t been devoured, and the villagers found some of them had actually been well looked after. The dragons promised to be less fearsome, promised to go to the local inn to mingle with all, and the villagers accepted there were prejudices on both sides. And, of course, they hoped to live happily ever after. End of story.

So why, you ask, do I tell you this story? I want to bury a sweeping generalisation that consultants are being excluded from the new commissioning arrangements. That may well be true for some but I am sure the fault for this lies with both sides. There are plenty of consultants who are refusing to engage, refusing to change.

I am sure there are plenty of challenges ahead and I’m not for a moment suggesting it’s “all ok” but locally you cannot accuse commissioners of not engaging with the consultants.

People have said we are “lucky”. Luck had nothing to do with it, amigos.

There’s much more to do but the relationships are now built. There is a belief and a trust that is mutual and, as consultants, we don’t feel out of the loop anymore. We are involved in it, in the thick of it, and the team consists of consultants, GPs, managers – all on an equal footing. So the dragons and the villagers got together, and they both got to know each other and gave each other a chance.

So, I ask you again: what’s luck got to do with it?

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