RM: Organisational challenges Colin Fleming Deputy Medical Director NHS Tayside

Reflects changing practice Need to be realistic about what can be achieved in information transfer in a consultation Need to support better info provision pre and post consultation

Health literacy? Patient buy-in? Shared decision making may create uncertainty for patients

great scope to improve care, reduce harm and use resources effectively organisations need to invest in systems based approach IT

Risk management critical for all organisations NHST linking clinical risks with other risks eg estate, finance, important Operational leadership important

scope for better conversations huge challenge scope for better conversations complaint culture and legal concerns often paramount in clinicians thinking realistic law, realistic press? Realistic law: A theory that all law derives from prevailing social interests and public policy. According to this theory, judges consider not only abstract rules, but also social interests and public policy when deciding a case.

personalised care ‘ Evidence-Based Medicine remains at the core of informing best practice and guidance, but for it to truly take place, we must use best available evidence, clinical judgement and patients preferences together ’

All good clinicians personalise care Revolution in genetic medicine, biomarkers, outcome measures , lends itself to improving personalised care New primary care contract with greater roles for allied health professionals should improve aspects of personalised health care Limits on personalised care come from greater use of guidelines, formularies, procurement Complexity of care can limit our best intentions

Realistic evidence/knowledge National/international level endeavour Need to be realistic about what we can do eg SIGN produce 4.3 guidelines per year past 10 years

good population health requires good links with HSCPs national direction presents dilemmas eg good care vs near care population medicine vs individual medicine- statins

Reducing unwarranted variation Needs a healthy clinical culture to challenge and understand variation

variation in practice may be at odds with innovation investment in more managed clinical networks, better IT focus on building teams, increasing effectiveness of MDTs

foster conditions to support innovation in care delivery

strengths in long view of NHS, commitment to research, research institutions and ethos associated with NHS innovation is stymied by red tape NHS often rewards failure risk taking behaviours and health delivery behaviours are not natural partners