SPOT analysis: Cutting bureaucracy and improving efficiency
This is the SPOT (Strengths, Problems, Opportunities, Threats) analysis for Cutting bureaucracy and improving efficiency, as discussed at the Leading Clinical Commissioning event held by NHS Birmingham East and North on 20 and 21 July 2010.
Add your views at the foot of the page.
Strengths
- New structure will reduce Quangos/arms length bodies
- Health well being boards
- Let the market open up
- Patient at heart
- Confront public concern about spending on NHS ‘management’
- Aligning need with decision making and money
- Scale demands cultural change
- Bonfire of ALBS
- Transparency of info
- Greater freedom to deliver service
- Efficiency and better VFM
- ‘leaning’ pathways
- More time for patient care/engagement, fewer targets. Potential for more local focus
- Leaner accountability
- Lots of good ideas & schemes (in pockets)
- Good collaborative clinical relationships
- Green light from white paper
- Great idea! – not all of us think this
- Diverting resources into practice/people
- Make it simplier for people to understand and connect to (opportunities)
- It reads well, says the “right” things
- Protected budget (for organisation)
- GP’s not risk adverse
- Peer group effect
- GP’s good at selling a product – (patient education)
Problems
- Too much process
- Pay rates/professional nation
- Governance
- Provider service could add to layers of bureaucracy
- Losing strategic view subjective target
- Lack of incentives for GPs
- Lack of clarity of what will replace GPs
- Disconnect between system set up for social insurance but actually tax funded
- Loss of experienced managers skills/jobs
- Loss of clinical time if diverted to management tasks
- Loss of management info to support best practise/safety/dignity
- Fragmentation of resource
- Heavier reliance on formal contracts
- Risks to ‘business as usual’ while changes being implemented
- Maintaining staff morale/interest/commitment
- Maintaining quality
- Parkinson’s law
- Payment structures
- New service slow to scale up
- Consultation about change slows down process
- Lack of PCT irony re: style of today’s event
- Can current stakeholders undertake this transformation (self interest/skills etc…)
- Citizen sound bits– but no real involvement & power in the design
- There are systemic problems with current delivery arrangements – how will these be designed out of the new system?
- Shortage of resources
- GP fatigue
- Resistance to change
- Inappropriate activity/inactivity
Opportunities
- Include more patient/user Choice
- Transparency
- Increase efficiencies
- Understand what adds value
- Genuine innovation
- Open to ideas of private sector
- Patients take control
- Direct engagement by patients
- GP commissioning/opportunities for increased delivery ‘closer to home’
- Improved pathways of care access Birmingham, better shared learning
- Flexibility for localised working
- Further social enterprise opportunities within community providers
- OPPs to provide things differently
- OPPs for new contracts/business
- Cut low value outpatients acute & mental health
- Reduce inpatient length of stay (acute mental health)
- GPs to cut the crap in 1’2’3 care
- Education and training led by providers to fit new services
- Competition between new providers
- Slim down networks (cardiac & cancer)
- Co-design with patients/careers & others e.g. third sector, be radical
- Radical redesign save cost around the person
- Patient lead agenda
- Involve patients in developing services
- LA voluntary agency integration
- GP provider development
- New services and prevention
- Redesign services
Threats
- Postcode differentials
- Cut the wrong things
- How to ensure quality
- Less money than expected
- Cuts in social services = greater
- Demand on NHS
- Rising remand
- Collapse of coalition
- Pandemic threats
- GP commissioning thread to existing contracts
- Thread to GPs approaches as employers – terms & conditions
- Potential threat to health & safety
- Potential conflict of interests by GPs employing own pt/pod destabilising core services (cherry picking)
- Loss of services seen as not priorities
- Cultural bureaucracy
- Leads to less efficiency
- Conservatism and organisational inertia!
- GPs antipathetic to private sector
- Bureaucracy – it exists!
- Potential for individuals to make choices which might ‘harm’ them in the future
- GPs – don’t know/how will GPs cope with deluge
- Threat to clinical care
- Disengage (hand over experience from fund holding)
- Losing good clinical to management
- Identify new unmet needs
- ?Fraud
See also: LCC SPOT write-up (Word doc) – plus comments
