Watch your language! – and the need for planning
2 August 2019
As all levels of communication become more complex and nuanced, language is becoming ever more important; not only in how it is used but more importantly in the specific message the user is trying to convey. We see this most obviously in politics today where a misplaced word can make a statement mean something different to that intended, this being further exacerbated in a world of social media where statements can easily, sometimes deliberately, be taken out of context and misrepresented. Never has language and meaning been more important than it is today.
What does this mean for us? I think that the way we use language to describe the services provided by optical practices is vital as this sets the tone and definition of these services. As I meet with LOCs and commissioners across the country, I hear a lot about the delivery of community services. It is true that optical practices deliver services in the community. But in the NHS the word ‘community’ is used very differently and bears no relation to the services that are provided by optical practices. We need to be very clear about this and avoid using the term ‘community services’ – our terminology must be ‘primary care’ and ‘practice-delivered services’.
This has been recognised by the Clinical Council for Eye Health Commissioning when they state that primary care services should be commissioned from primary care providers. By talking about community services, we may inadvertently give the impression that the services can be delivered in locations outside of optical practices and by non-primary care practitioners. We must use language explicitly and talk about services that can be delivered in practice by primary care practitioners.
Another issue is how we term the services that we deliver. Again, around the country I often here them spoken about as ‘schemes’ which again gives rise to ambiguity. The word ‘scheme’ implies that the service being delivered may be temporary or aimed at solving a transient problem. It may also imply that the service being delivered is experimental. We know from our experience and evidence to date that services such as MECS are not experimental or transient but rather are a key part in delivering an integrated optical pathway via primary care. As such we should stop using the term ‘scheme’ and start talking explicitly about the ‘services’ that are provided, and that they all build on a significant amount of experience, evidence and data. I think that by showing confidence in the services that are being delivered we will collectively build confidence in the wider NHS about them.
Now, when is a plan a strategy and a strategy a plan? Often the two words are used interchangeably to mean the same thing and certainly I talk about this a lot when I can get to LOC meetings. My view is that we don’t need to spend long discussing strategy; we know that the direction of travel for the NHS is integration and care closer to home, outside of hospital. Throughout every NHS reorganisation of planning process these two core aims have remained.
Therefore, thought and planning has to be our focus, and what primary care needs in answer to this is a clear plan that can be delivered on three levels – national, regional and local. At LOCSU we work across all three areas. From a local point of view we have recently appointed a team of new Optical Leads to work with all LOCs to work up a locally-owned plan to address local patient and service needs. I urge all LOCs to engage with this process, and the early reports are that this has been warmly embraced by a number of LOCs.
To address the need for regional delivery, in the early autumn, LOCSU will be setting up seven regional LOC forums to map against the emerging NHS England regions. This will aim to facilitate close collaboration between LOCs across service planning and delivery in order to breed much-needed geographical and regional consistency; this is in answer to a need expressed to me by many commissioners.
Finally, LOCSU continues to engage, work and influence on a national level. Recent work, which often goes unseen, has included representing the sector on NHS IT forums, developing QIO and other regulatory work and most recently discussing NHS reform direct with NHSE alongside other optical and ophthalmology sector leaders.
LOCSU is further developing our plan to enable primary care to operate effectively at all three levels – to learn more about this, come to the NOC in November where this plan will form the cornerstone of all discussions.
In short, we need to show the NHS that we have a solid plan for the delivery of practice-based primary care services. Language is important but clarity of thought and planning plus ownership of the message is even more vital!