For some time clinicians have been unhappy about some of the Government's NHS reforms, and that they have been insufficiently involved in them. In 2006 The NHS Confederation began a project with the Joint Consultants Committee (now the Joint Medical Consultative Council, the JMCC) to ask doctors what it would be like to practise in a reformed NHS, based on their own vision or experience of creating change.

A clinical vision of a reformed NHS

With the JMCC, we asked a range of doctors what kinds of changes they would like to see, specifically:

• What would be different from current practice and what would it feel like to work in such changed services?
• How would relationships with patients and between staff be different?
• What would stay the same?

The resulting report tells the doctors' stories, sets out a number of design rules for providing high-quality services and looks at what doctors, managers, medical leaders and policy-makers need to do.

Report findings

Many of the doctors we spoke to were frustrated by aspects of the reform programme. Most were clear about what they want to achieve and were finding ways to make it happen. The level of energy, innovation and ingenuity we found was heartening and inspiring. Chapter 3 of the report contains a selection of stories from the range of doctors we interviewed.

From the doctors' responses, we identified a number of design rules - general rules providing a basis for providing high quality services. The rules are a set of ideas that do not dictate how they should be implemented. We believe they provide the basis for the sort of clinical vision that has been missing from the reform programme.

Conclusions

The JMCC and The NHS Confederation believe there are clear actions for Government, particularly on the process of involvement where a significant change of approach is needed. Policy must not make it hard to do the right thing for the patient. However, it is in the hands of clinicians and managers to create change in their own organisations. A failure to do so will leave serious consequences for the NHS and its patients.