This post is intended to give myself a good talking to. The end of my MSc in Strategic Leadership is in sight, and I am currently busy interviewing people as part of the data collection process. But am I working as hard as I can to write up the literature review, methodology and methods? No I am not? What am I doing instead? Well anything but working on my dissertation. You would imagine that my house would be spotless in that case wouldn’t you? Well I don’t appear to have been scrubbing floors or dusting the corners, so I haven’t suddenly become house proud. I have done quite a bit of weeding my garden as we have been having some very nice weather lately and I have also been out walking through the local countryside. Other than that, I am ashamed to say I don’t really have an excuse for my poor work rate. I have written about 2000 words of 20000 and if I am going to have anything half decent to present in June then I really must get on with it. Each time I decide to do a bit of blogging instead of writing or reading then I will do well to look at this post and remind myself to get on with it!

Yesterday I went off with a couple of colleagues to look around what was described as an integrated emergency / urgent care facility run jointly between the acute and primary care trust. For patients, and indeed for the visitor it all looks very nice, and people are getting really very good care and on the ground the nurses and doctors, who work for both sectors but work together are doing this in a pretty much seamless looking way. Underneath though there are still problems. For example the PCT still gets charged for the patients attendance, even though they could see a nurse employed by the PCT. Payment by results could end up being the biggest wedge between acute and primary care, after all why wouldn’t the acute trust want to continue to see patients if they are getting paid for each person who walks through their doors. In our own area the barrier to developing any kind of integrated facility is the relationship between the two sectors and the ensuing arguments are likely to have an effect ultimately on the care a patient receives. It was amazing to see GPs who work for the out of hours service working in the A&E environment and actually seeing patients who walk in to the urgent care facility, helping with the education of the nurses there particularly in the area of minor illness and also learning more about the treatment of minor injury in the process. I just hope the different cultures of primary care and secondary care can come together in the longer term or else this could end up being another one of those expensive projects that is begun and never carried through to its full outcomes. One of my main concerns with this whole thing though is the continued use of management / business consultants. I know it is easier to hand a project to a person or group of people to see through, but can you tell me why a) we don’t have the expertise in house, or if we don’t why we can’t create it, because this is a massive and surely unnecessary cost to the NHS!