Healthcare is a complex system. Healthcare providers work with clinical commissioning groups, consortia and national commissioning bodies to deliver a blend of local and specialist services. Working above and across these groups is NHS England/NHS Improvement (NHSE/I), acting as the over-arching governing body, balancing strategic responsibilities with high level operational oversight.

Within these apparently individual elements move the professional bodies (such as the Royal Colleges) and special interest groups (including the Society for Endocrinology). Their role is to inform, influence and raise awareness of emerging important issues.

The challenge is how to encourage such a complex system to work better, while avoiding the trap of a ‘command and control’ approach that can stifle innovation and threaten the autonomy and self-determination that are key attributes of the high-performing individuals and organisations within it.

One well-trodden path would be to seek further structural change. Yet, we know that, within complex systems, such change may fail to deliver the desired outcome. We need to resist the assumption that there is a structural solution to a process problem. So, what is the way forward? How can we encourage our complex healthcare system to get better?

Working from within, rather than from outside, the system, clinical reference groups (CRGs) and the Getting It Right First Time (GIRFT) programme look to deliver the horizontal and vertical co-ordination that will enable the system to improve at pace and at scale: leading to improvement aligned with shared strategic priorities and shared standards.

CRGs are uniquely positioned to fulfil this role through their composition and relationships. While CRGs exist to support NHSE/I in 'business-as-usual functions', they are also sensitive and responsive to the wider system. They are made up of commissioners, topic experts and service user group representatives. They speak the language of all key stakeholders and can gather both the national and the local intelligence that is required to improve outcomes and experience for patients.

The Specialised Endocrinology CRG is chaired by Neil Gittoes (Birmingham). The CRG has four workstreams. Within these there are currently a number of strands, each assigned a priority and timeline:

1. Measuring and improving quality: including workforce
2. Supporting effective commissioning
3. Improving value and reducing variation
4. Transformation

An over-arching clinical priority for the CRG is to support the introduction of new or revised pathways of care across specialised and non-specialised units, to facilitate joined-up working across geographical areas. We also recognise the importance of working beyond endocrinology and linking to other CRGs. For the year 2019/20, the focus is on pathways for adrenal cancer and for total pancreatectomy and islet auto-transplantation for patients with chronic pancreatitis.

As we move forward, the CRG will be an important agent of change within the system. Its success hinges on wide engagement. To this end, the intention is to make the CRG visible and for its processes to be transparent. We very much want to be approached by clinicians and professional groups with ideas. Please get in touch in person or by email:

Neil Gittoes: [email protected]

Steve Ball: [email protected]

Miles Levy: [email protected]

John-Newell-Price: [email protected]

Tristan Richardson: [email protected]

Helena Gleeson: [email protected]

 

Steve Ball, Society for Endocrinology Representative, Specialised Endocrinology CRG