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Contents
Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
1.Participants2.Introduction – Stephen Singleton3.What we know so far – John Burn4.Creating the future role of clinical leadership
•Team Alpha•Team Bravo•Team Charlie•Team Delta•Team Echo•Team Foxtrot•Team Golf•Team Hotel•Team India•Team Juliet
5.How would this work in reality?•Outcomes, Continuous Improvement and Innovation•Function of Clinical Senates•Service Configuration & Support & Advice•Voice of Clinicians•Divergence of Practice, Assurance and Variations•Model of Networks•Clinical Commissioning Groups•Function of Networks•Health and Wellbeing Boards•Principles of Clinical Leadership
6.Developing our opinion•Outcomes, Continuous Improvement and Innovation•Service Configuration & Support & Advice•Health and Wellbeing Boards•Clinical Commissioning Groups•Model the Relationships•Function of Clinical Senates/Configuration of Senates in the North East•Principles of Clinical Leadership•Model of Networks•Function of Networks
7.Close
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Participants
Alison McLaughlinAlistair Gascoine
Andrew CantAndrew Kilner Andy Roberts
Andy RobinsonAnnette McAdam Bolescaw Posmyk
Brendan HillBridgid Joughin
Carl ParkerCarol Hardy
Carol HedlandCarole Kaplin
Caroline GraysonCaroline Thurlbeck
Chris BrownClare ScarlettCynthia Atkin
Doraisamy Parthasarathy David BeaumontDavid Bottoms
David EvansDavid Landes David Thorne
Dominic Slowie Edward Kunonga
Elaine O'BrienElizabeth MoodyEmma Champley
Gerry Stansby Gillian JohnsonHenry WatersHilary LloydIan Pattison
Isabel GonzalezJackie Kay
Jane Bowie
Jane LeighJane Mullholland
Jean FreundJeremy Henning
John BurnJohn Costello
John O'Donoghue Jonathan BerryJonathan Smith
Joyce LovellJudith Stone
Judith ThompsonJulie TurnerKamini Shah
Kathryn Dimmick Kyee Han
Laura RobsonLesley DurhamLesley Jeavons
Louise WilsonLynda Dearden
Margaret McQuade Marion UsherMark LambertMartyn Boyd
Maurya Cushlow Martyn Farrer Melanie BrownMichael Milner Michael Norton
Mike GuyMike PrenticeNamita KumarNeil Reveley Nicholas Land
Nick RoperPaul HansonPaul Moffat
Paul StainesPeter Mercer
Richard BarkerRobert WilsonRobin MitchellRoy McLachlan
Ruth Evans Sam Cramond
Sarah Rushbrooke Sharon Haggerty
Simon EatonStephen Cronin
Stephen SingletonStephen Sturgiss
Sue Prout Suresh JosephTony Gibson
Yvonne Evans
Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Introduction – Stephen Singleton
The timing of this is important. Now is exactly the right time to have a conversation about change management. One of the things to reflect upon as we pass to the new system is what are the things that have been successful, and what hasn’t. Consider what can we do to influence the future. This is not a drive-you-hard-until-4 o’clock-and-give-me-the-answer kind of day, but a day to have the conversations we need to have.
I was in a meeting last night, talking about the major trauma network. We are down to only a handful of patients a day who at the moment go through the wrong pathway, get the wrong care, and die. We need to make the right decisions and not confuse leadership with a strong CV.
This is a fundamental point. Clinical is not code for doctors. Clinical means the 55 000 odd people who see patients and directly influence patients through
their care. How this voice and majority voice influences the system. Clinical is how we mobilise these conversations of influence.
How we see things, how we change things and make them better for the whole system. We need to have systems centred around people and patients. We do this by having real vision, and real method to change. It could be by clinical senates, or networks. The method could be anything you like. What we’ve learnt in the North East is that it is about vision, ambition, and culture. This thinking is part of the reason is why the North East does relatively well.
Most of our people believe any of the breakthroughs we have are due to science. For example a new operation or procedure comes along, or medicine. A lot of what networks have been doing already is managing these breakthrough strategies. What is absolutely crystal clear is that if you leave it up to just the science, nothing will happen. You need strategies in place to get breakthroughs. I see the potential of clinical senates and networks to manage these breakthroughs. Can we find a way of developing better breakthrough strategies?
To paraphrase Einstein: ‘If the world was going to end in an hour, I would spend 59 minutes trying to work out what the problem was, and 59 seconds working out the solution.’
I am a little like the emperor in gladiator, lying in his tent, dying, and has the idea – ‘I know, ill hand Rome back to the Senate!’
The SHA is dying, so I’ll hand over to John. He’s the general.
To view Stephen’s presentation click here
Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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What we know so far – John Burn
We can network. An example of this is between Bill Cunliff, and Elizabeth Kendrick. Elizabeth is not only is the mother of two sets of twins under the age of 5, but manages to lead a clinical innovation team. The difference here is that leadership is not about a CV but the ability to lead a service.
Bill Cunliffe took a look at practices regarding patients undergoing bowel surgery. He determined that our reasoning was flawed and outdated. By challenging and changing some of our assumptions, the patients mostly get to go home sooner. Not because we are kicking them out, but because they are getting better quicker. It can be done. We can make these breakthroughs if we want and if we are willing to look at ourselves, and challenge ourselves to change.
Some of the questions we need you to address are:• The clinical network – should we integrate clinical networks?• What is a network?• How do you measure this? How do we now if they are failing, or doing their jobs well?
Many of the problems we have in the North East are self-inflicted, and we pick up the pieces. What can we do to get upstream from these health issues and stop the supply to these problems?
Clinical senates. We want the whole clinical community to contribute to the health of the North East. How many of these should we have? How do they interface with networks, CCGs, HWBs, Las and FTs?
Ill go back to the first slide – the big picture. In the land of the blind, the one eyed man is king.
To view John’s presentation click here
Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
Creating the future role of clinical leadership
TEAM ALPHA
Alison McLaughlinAndy RobertsCarol HedlandDavid Bottoms
David EvansDoraisamy Parthasarathy
Michael MilnerMark Lambert
Nick RoperSuresh Joseph
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Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
Creating the future role of clinical leadership
TEAM BRAVO
Carol HardyCynthia AtkinDavid LandesIan Pattison
John CostelloJonathan Smith
Judith ThompsonPeter Mercer
Sharon Haggerty
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Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
Creating the future role of clinical leadership
TEAM CHARLIE
Carl ParkerChris Brown
David BeaumontDominic SlowieHenry Waters
Maurya CushlowPaul Moffat
Stephen CroninSue Faulkner
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Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
Creating the future role of clinical leadership
TEAM DELTA
Bridgid JoughinDavid Landis
Gillian JohnsonJeremy HenningRobin Mitchell
Ruth EvansRobert Wilson
Stephen SingletonYvonne Evans
Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
Creating the future role of clinical leadership
TEAM ECHO
Alistair GascoineBrendan Hill
David ThorneJoyce LovellJulie Turner
Laura RobsonLesley DurhamLesley Jeavons
Sarah Rushbrooke
Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
Creating the future role of clinical leadership
TEAM FOXTROT
Gerry StandbyJane Mullholland
Jean FruendJohn O'Donoghue
Lynda DeardenMike PrenticeNeil ReveleyPaul StainesTony Gibson
Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
Creating the future role of clinical leadership
TEAM GOLF
Andrew CantBoleslaw Posmyk
Clare ScarlettGill Rollings
Jonathan SmithKyee Han
Louise WilsonMarion Usher
Mike Guy
Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
Creating the future role of clinical leadership
TEAM HOTEL
Caroline GraysonEmma Champley
Hilary LloydKamini Shah
Margaret McQuadeMartyn Boyd
Namita KumarNicholas LandSam Cramond
Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
Creating the future role of clinical leadership
TEAM INDIA
Carole KaplinCaroline Thurlbeck
Elaine O'BrienJackie Kay
Jonathan BerryMartin Farrer
Richard BarkerRoy McLachlan
Stephen Sturgiss
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Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
Creating the future role of clinical leadership
TEAM JULIET
Christine BriggsElizabeth MoodyIsabel Gonzalez
Jane LeighJohn Burn
Kathryn DimmickPaul HansonSimon Eaton
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Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
How would this work in reality?
TEAM ALPHAOutcomes, Continuous Improvement and Innovation
Bridgid JoughinCarole Kaplin
David BeaumontJean Freund
Kyee HanLesley DurhamMark LambertNeil Reveley
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Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
How would this work in reality?
TEAM BRAVOFunction of Clinical Senate
Alistair GascoineAndy Roberts
Jonathan SmithJohn Burn
Lynda DeardenMichael NortonMike PrenticeSuresh Joseph
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Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
How would this work in reality?
TEAM CHARLIEService Configuration & Support & Advice
Carol HardyCaroline Grayson
David LandesDoraisamy Parthasarathy
Julie TurnerTony Gibson
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Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
How would this work in reality?
TEAM DELTAVoice of Clinicians
Andrew CantJane Leigh
Jeremy HenningJohn O'Donoghue
Lesley JeavonsMartyn BoydMartyn FarrerYvonne Evans
Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
How would this work in reality?
TEAM ECHODivergence of Practice, Assurance and Variations
David EvansEmma Champley
Hilary LloydLouise Wilson
Roy McLachlanStephen Singleton
Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
How would this work in reality?
TEAM FOXTROTModel of Networks
Alison McLaughlinBrendan Hill
Gillian JohnsonHenry Waters
Isabel GonzalezJudith Thompson
Richard BarkerStephen Sturgiss
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Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
How would this work in reality?
TEAM GOLFClinical Commissioning Groups
Chris BrownDominic SlowieGerry StansbyJohn CostelloJoyce Lovell
Kathryn DimmickNick RoperSue Prout
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Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
How would this work in reality?
TEAM HOTELFunction of Networks
Bolescaw PosmykCynthia AtkinDavid ThorneIan PattisonJackie Kay
Paul StainesSarah Rushbrooke
Stephen Cronin
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Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
How would this work in reality?
TEAM INDIAHealth and Wellbeing Boards
Caroline ThurlbeckClare ScarlettMarion Usher
Melanie BrownMichael Milner
Paul HansonPeter Mercer
Ruth EvansSimon Eaton
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Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close
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Team Members
How would this work in reality?
TEAM JULIETPrinciples of Clinical Leadership
David BottomsKamini Shah
Margaret McQuadeMaurya Cushlow
Nicholas LandRobin Mitchell
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Contents Participants Introduction What we know so far Creating the future role of clinical leadership
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Developing our opinion
TEAM ALPHAOutcomes, Continuous Improvement and Innovation
Situation / Issue Role of the Clinical Senate Role of Clinical Networks Role of CCG’s
Network Priorities for example Enhanced recovery (ERP) vs Hyperactive Stroke or gaps in service.
Spot gaps in Network coverage compared to population need and expenditure and consistency of approach
Develop ERP and support implementationStandard setting and monitoring
Specify ERP in commissioning brief
Example of things that could be sorted with a different approach;
• Obesity Prevention 30 SUCS
• Vascular services
Commission + Decommission networks ?(starting and stopping them)Determine number and scope of networks
Supporting QIPP workstreamsA better connection between clinical improvement and potential for saving moneyEvaluation of specialised services (e.g. ICNARC)Showing the benefits of improvementsManaging cover for interventional radiology
Evaluation of services and improvements (Statutory Responsibility)
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Teamlist
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Developing our opinion
TEAM CHARLIEService Configuration & Support & Advice
Service configuration issues• How bodies seek advice• How commissioners ask for advice• Relationship with other bodies – local/national• Statutory services • Politics – local/national• Advice being challenged... How to prepare for this
Why have some issues not been resolved?• Self interest• Perverse initiatives (e.g. status)• Organisational interests (money,
recruitment/retention. NB: sometimes services loses money but reputation and ‘house of cards’ argument and research magnet)
• Public opposition• Assumptions about safety• Self interest about local services• Barmy people
• Therefore Senate has to be very clear about what it can do and what it can’t.
Senate
SoS
OSC
IRP
College etc
Reconfigurations1. Senate won’t, can’t and shouldn’t be a substitute for
competent local work and needs to react clearly when asked to do something ie ‘in scope?’ – yes or no
2. Can arbitrate/honest broker when• Technical advice isn’t definitive• Local solutions vary from national advice• Danger of a purely commercial decision by
provider3. Senate needs to be sufficiently robust * to give
advice that a provider or commissioner can follow without increasing their risk
4. Clear division of labour between senate and IRP and NCAT
5. Clear relationship with OSC power to refer6. *avoids being too susceptible to judicial review7. Role between network and senate is clear:
Network: technical, specialist, evidence etSenate: Arbitration, balanced advice etc (politics)
NB Senates can’t do much about this = provider/CCGs will still have to do consultation/education
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Walls AssignmentsAdditional Materials
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Developing our opinion
TEAM INDIAHealth and Wellbeing Boards
So...• A health and wellbeing board might seek advice from
a clinical network on matters related to the JSNA and W&W strategy.
• A clinical network night nudge or challenge a health and wellbeing board towards better/best practice
• Sufficiently noisy question from health and wellbeing board might prompt the creation of a new clinical network
• The relationship should/will be dynamic given the cross membership between CCGs and FTs
Nudge challenge
Health and Wellbeing Board
CCG Health Watch
Patients
Clinical Network
Questions help related to HAWES
H&WB Strategy
JSNA
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Developing our opinion
TEAM GOLFClinical Commissioning Groups
Senate• Clinical advice• Advice of all networks• Role is authorisation = CCG meets behaviour
requirements not direct regulation• Advise communication board• Independent advice and second opinion• 20 people possibly populated from another area –
active/credible and respected• Potential conflict of interested could be influencing
providers in response to questions• ?conflict between Senates dependant on number of
senates – regional and nationally• Local arbitrator on tough decisions
Potential tensions, professional representation/task required
Could be a pool of people multi disciplinary professions.
Questions•How funded?•Top sliced?•CSU to host?
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Developing our opinion
TEAM ECHOModel the Relationships
“Federation”CCG & HWB
Tasks Clinical Networks
CN CN CNCNCN
Detailed opinion , evidence and argument regarding way forward to Federation
Senate
Unresolved issues
Major changes across providers / areas
Task withquestions
Advise way forward
Regional Outpost
NCB
DH
Regional or Sub Regional?
?Advisory with Authority?
????
Raise issues
?
representatives
Supervises
CCGHWB
CCGHWB Independent
advice re key areas needing attention
Loca
l
Any qualified providers
CP Issue and discussion
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Developing our opinion
TEAM BRAVOFunction of Clinical Senates and Configuration of Senates in the NE
Senate
Individual networks
The Clinical NetworkSecretariat/Admin
CCGsProviders
For b
ig diffi
cult
issue
s
Resource ?
Oversight ?
Performance Mgt ?
RolesAll to have:• Spec terms• Governance and
board structure• ?Advice to providers?• ?Q/A
NHSCB
? Type of Network? Power? Work streams? Funds
£
CCG ProvAudit
performance
Senate
Providers
The Network
Sub
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Developing our opinion
TEAM JULIETPrinciples of Clinical Leadership
Organisational workplan to identify:• Passion• Vision• Strategic thinking(no nepotism)
PDP – talent spotting talent grooming
• Development programme• Coaching• Mentoring• Feedback – continuous improvement• Opportunities for leadership – graded facilitated
Inappropriate self selectors – weeded out!(management ≠ leadership, loudest voice ≠ best leader etc)
Important characteristics• Humility • Charisma• Personal insight• Comfort with uncertainty• Comfort with accountability• Ability to articulate and communicate passion and vision• Ability to be the voice in the wilderness• Innovative – creativity/new ideas• Listening
Principles• Honesty/trust• Integrity• Authority – earned/delegated• Time limited tenure•Well and appropriately networked•Measured risk taking
Appr
aisa
l
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HWBs
SoSNHS Comm
Board
Developing our opinion
TEAM FOXTROT Model of Networks
Senate will only work if:- Listens to - Owned by- Works on behalf of
CCG/HWB - where accountability rests(NCB & FTs)
Clinical effectives of senate relies on:- Communications- Courtesy- Consideration- Cooperation- Connectivity- Conciliation- Consensus- Courage
ComparisonNICE- Authoritative- Of the system- Power??
Questions- Facing up/down? - Influence
• Advisory but open to public scrutiny• Netag model – multidisciplinary, authoritative,
independent senators leave their ‘bag’ at the door • Empowered to co-opt experts• Agenda setting? accessible but focus
on issues of broad relevance• Broad church• Need skilled secretariat
CCGs
FTs
Private Providers
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LAs
MPs3rd
Sector
Networks
Senate 12
NHS CB
FTsCCGs
HWBs
The Clinical
Network
FTs
What is the work plan? Proactive or reactive?
AppointedElected- Respected
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Developing our opinion
TEAM HOTELFunction of Networks
Function of network• Perform/meet/facilitate National Mandate• Provide advice/not statutory recommendations• Provide single point intelligence - NICE • Provide independence• Provide evidence base• Honest broker role• Maintain integrity• Pathway orientated• Facilitate equity of access• Advise of:
• Saving lives• Saving money• Improving patient experience
• Create/assist in service planning to support commissioning
• Improving quality standards/outcomes• (operational function)
Federated CCG and Senate• Very useful to some Neworks but not all• One size doesn’t fit all (National versus Local funding)
Network issue• Resource availability
Senate
Networks
CCG CCG
NCB
HWB HWB
FT FT FT
LA LA LA
CCG
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Close – Richard Barker
The more organised we are the more we can bring about change and effect the way we work. Hopefully this will be a valuable milestone, there was a large consensus gained throughout the day on what we need to do going forward. Thanks everyone for all the hard work
Contents Participants Introduction What we know so far Creating the future role of clinical leadership
How would this work in reality? Developing Our Opinion Close