1. RM: Organisational challenges
Colin Fleming
Deputy Medical Director
NHS Tayside

2. 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

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

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

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

6. 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.

7. 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 ’

8. 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

10. 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

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

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

14. 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

15. foster conditions to support innovation in care delivery

17. 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