Saturday, November 22, 2014

Step Up. Or Step Down

I sat in the room- and looked around while sipping on my umpteenth coffee for the day. I was surrounded by folks I had trained with, passionate individuals who were Diabetes Consultants all around the country- and the frustration was palpable. This wasn't a meeting of folks who weren't interested, disenfranchised..those who has refused to come out of their "ivory towers"...those who simply sat in committees and nodded sagely...no...these were folks from whom the energy and passion to improve diabetes care- simply put- burst through in abundance.All keen and ready with ideas, thoughts- willing to work within, with- whatever was needed to do- primary care colleagues to improve care locally- and simply blocked and frustrated by progress.

During the day, we had some great discussions, thoughts exchanged, speakers who represented acute trusts, CCGs...and finally near the end of the day, one of the speakers hit the nail bang on the head. "You need to raise your identity within the Trust"...and there it was...as simple as that.

I have commented earlier on the evangelist few GPs who speak for no one and have caused more harm to diabetes care than anyone else. There is no getting past that...by trumpeting that diabetes can be done in the community by primary care ("and no, we don't need specialists")- swaths of patients moved out- without much support from specialist teams- and now we are all suffering- most importantly- patients with diabetes simply sue to the sheer volume as well as variability in diabetes care provided. But as regards specialist teams, the damage to them has been done by their own leaders who appeared toothless in the face of the changing world, struggling to justify their existence and consequently sacrificing the identity of diabetes teams within Trusts. As soon as that was done, their role,as deemed by their own medical colleagues became to be to do jobs no one else wanted. They got tied into Acute Medicine, General Medicine- anything really while politics played its part, other medical specialities explained to powers that be how amazing their own speciality was...diabetes got sidelined- and a combination of lack of cojones, leadership, timid personality and an element of self protection- all combined to turn diabetes teams into "teams which did what others didn't".

The irony of that is telling now...when the opportunity has arisen, when the community is actually opening its doors, when CCGs are perhaps looking at models of care, when even Simon Stevens is talking about working in the community....the diabetes teams have nowhere to manouveur..as simply its the fundamental question...if you don't do "what others don't want"...who the heck does it?

To be honest, I actually sympathise with every acute trust with that dilemma. It isnt their fault that diabetes leaders were and continue to be rudderless- without any direction to what a specialist should do within an acute trust. It isn't their issue that diabetes teams have indeed opted to do other work afraid of commiting into the community- and it isn't their fault either that most are starting to see the light- yet perhaps too late. Every acute Trust would of course love to see their own Consultants improve care in the community but their dilemma is simple- they need to look after the patients within the Trust too.
I don't blame other specialities either- they are doing what anyone else would. I don't think its with any dastardly preconceived plan to screw diabetes teams- but simply using the opportunity to showcase their knowledge and show how they could improve care - the cardiology example shows the benefits of focussing on speciality. That's life, that's politics- that opportunity was taken- its the fault of us as a diabetes community that we sat back- so its really difficult to now wringing ones hands when our leaders have failed so badly- not just their colleagues- but also the very patients they are supposed to serve.

The team was recently commended by a judging panel- comprising of the RCP- in the acute sector innovation in the HSJ Awards. There was a specific reason why I went for that- it wasn't the lure of "yet another" but making the point that a diabetes team could show innovation within the acute sector- without simply doing what "others didn't like". It's telling to see us as the only diabetes team within the acute sector category...it tells its own story, doesn't it?

So to all those leaders of the diabetes Consultants, here's an open tip...stop wringing your hands, showcase to acute Trusts and CCGs what a specialist can offer within a Trust and the wider community. Show in the brave world of Accountable Care Organisations, Primary and Acute Care System, the diabetes specialists has an immense role to play...maybe even suggest who would do the jobs outside diabetes care that present folks do within trusts, so Trusts aren't compromised either. Free the diabetes specialists to work with primary care, create the PACS- enhance the reputation of Trusts further..the opportunities are endless.

If you can't, then stop organising conferences, meaningless meetings, producing documents of worthless value. Suggest you save the polar bears and step down. There's a reason why there isn't a flood of trainees opting for this speciality...they don't even know what kind of jobs they will have to do in the future. If you can't even justify your own existence, there's little hope for you explaining the role of a specialist- let alone improve patient care.

Go to work on Monday...maybe even ignore the next CEA round- look in the mirror and have a think whether you are doing justice to the role of being a national leader in diabetes. The options are indeed very simple. Step Up. Or Step Down.

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