Dr Michael Dixon, a practising GP in Cullompton, Devon is to retire as chairman of NHS Alliance, a post he has held for 18 years, at the end of this year.
Dr Dixon said: “The NHS is transforming itself at an unprecedented pace and scale, and NHS Alliance has been doing the same. I believe the time for single-focus organisations representing discrete parts of the system has gone. It’s not about ‘hospitals’ or ‘primary care’ anymore, nor about siloed membership or representation. NHS Alliance has never shied away from disruptive innovation, but formal structures and fanfare conferences no longer feel relevant.
“Our vision for the next phase of NHS Alliance is as a virtual organisation with light-touch governance but firm direction, harnessing digital and social media, and based on crowd-sourcing principles of ‘followship’ rather than restrictive membership. We won’t lose our core values of immediacy and responsiveness, and our focus will remain on innovation, talent and representation; but our representation will be far broader, based on common purpose across the system to break boundaries and dissolve the tensions and self-interest that get in the way of truly progressive healthcare. This will be a place, as it always has been, where great ideas can flourish with little constraint.
“The health service of the future should be nimble and flex to local needs, based on principles of collaboration and integration, and be relationship rather than process driven. Over the past three years, NHS Alliance has itself reflected this direction, attracting a constituency that extends far beyond our roots in general practice. We have reached out to housing organisations and associations, the fire and police services, and deep into the community itself, to understand better how to improve public health, and develop a health service that intertwines with, and is interdependent on, our everyday world. The populations we serve are themselves an engine for public health.
“18 years is as long as any chair should serve. When we first founded NHS Alliance, we agreed that every conversation should be about how we could improve patient and community care and health. We didn’t waste time discussing abstract ideas and that may be because we were all frontline clinicians, impatient and wanting to make a difference. I had assumed these attitudes were rife throughout the health service but have found that too many people are more concerned about protecting their own interests and the status quo. I believe that NHS Alliance is one of the few true champions of the NHS.
“That makes it loved and loathed, praised and condemned in equal measure, but as a result it has always played a key role in influencing the governments people have elected. As chair, it has been enjoyable, inspiring, and invigorating and I wouldn’t have missed a minute of it. Our most notable ambition – to see healthcare shaped by the clinicians delivering it at the frontline has been achieved. And now, as Vanguards and new models of care take shape, and we begin to see a vital new force for change and provision emerging, it is time to step aside and allow our own vanguard of passionate, innovative and talented leaders to shape and drive a new kind of organisation, a new NHS Alliance – a genuine alliance of people and organisations, passionate about making a positive difference – that reflects a new kind of healthcare.
”I leave it to them to share their vision publicly in early December, and while I will always be there as a touchstone when needed, it is time for a new force to meet the needs of ‘now’ and not what ‘was’.”
Rick Stern, chief executive, NHS Alliance said: “Michael has been an inspirational leader. Never afraid to challenge and disrupt in the interests of patients, doctors, nurses and the wider body of health professionals in primary care, he has left an extraordinary legacy. Many of us joined NHS Alliance because of Michael, drawing us in with his warmth and humour. He is brilliant at connecting with people and he knows how to use the practical concerns of front line practitioners to shape and influence policy at the highest levels. We will miss him greatly, but we are both proud to have attracted a new cohort of inspirational leaders, and now look forward to supporting their collective vision.”
Notes to editors
For further information please contact Sarah Wrixon, firstname.lastname@example.org, 07976 747067 or 24 / 7 media line 07725 555030
1. Michael Dixon OBE: Profile
Michael Dixon graduated in psychology and philosophy at Oxford University before studying medicine at Guy’s Hospital. Since 1984 he has been a general practitioner at College Surgery in Cullompton, Devon. In 2008, he and his partners created the “Culm Valley Integrated Centre for Health”, widely regarded as a prototype for general practice of the future.
From the early 1990s, he was a leader of the GP / clinical commissioning movement aiming to give frontline clinicians a far more influential role in improving local services and health. He co-founded one of the first Locality Commissioning Groups in Mid Devon in 1993 and served on the National Executive of the National Association of GPs before becoming the first chair of its successor organisation, NHS Alliance, in 1998. He has continued in this role, by annual election, to the present day. In 2012, clinical commissioning was fully embedded in statute with the creation of Clinical Commissioning Groups (CCGs). A new organisation, NHS Clinical Commissioners, was created to represent CCGs bringing together the commissioning arms of NHS Alliance, NHS Confederation and the National Association of Primary Care.
Recent national roles have included: chair of the National LifeCheck Board, special advisor on practice based commissioning to Lord Darzi and sitting on the steering group of a King’s Fund Enquiry into the future of general practice. Today, he is a member of the National Stakeholder Forum, sits on the National Steering Group and the National Strategy Group for Clinical Commissioning. He is also a member of the NHS Sustainable Development Unit National Advisory Group.
Since 2007, he has been visiting professor to the University of Westminster (Integrated School of Health) and was also appointed visiting professor of University College, London in 2012. He is an honorary senior fellow in Public Policy at HSMC (University of Birmingham) and honorary senior lecturer in Integrated Health at the Peninsula Medical School. He is a regular writer and broadcaster, having written several books including “The Human Effect in Medicine” and is president of the Health Writers Guild.
Throughout he has been strongly supported by his wife Joanna, a professional artist, with whom he has three children. He is a keen gardener and fisherman, when time permits.
2. NHS Alliance: Delivery summary
- 2015: Making Time in General Practice: commissioned by NHS England to address bureaucratic overload in general practice
- Practice Nursing Forum launched:
- Health in Housing launched,
- Momentum, a collaboration between NHS Alliance and the National Association of Primary Care to support clinical leadership in new models of care, formed
- 2014: Think Big, Act Now: Creating a Community of Care published
- Catalyst and Accelerate launched
- 2013: Breaking Boundaries published
- 2012: New Provider Network launched, Innovation Network launched
- 2011: Breaking the Mould without breaking the system – new ideas on 24/7 urgent care
- 2005: Fast Forward published
- 2004: Making a Difference published
- 2000: Implementing the Vision published
- 1997: Restoring the Vision published
3. The original vision
The fundamental aim of NHS Alliance when it first launched in 1998 was to raise the profile of primary care, clinical leadership and local decision making (to counter balance a historically centralised NHS).
- It was a precursor for clinical commissioning in its first guise, The National Association of Commissioning GPs, which morphed into Locality Commissioning, PCGs, PCTs, Practice Based Commissioning to, eventually, Clinical Commissioning Groups.
- It has been a long term advocate of primary care and its potential role to offer more services and greater health impact within communities, evidenced by a series of policy-shaping documents that have had an impact on white papers and government policy. It has intervened when primary care was being side-lined. Most notably, perhaps, with the Darzi Strategy, when it fought within for a separate primary care strategy.
- In the development of primary care, it has argued for the need to retain the benefits of general practice as it is, but also to garner the benefits of general practice at scale, which can provide better unscheduled access, more services outside of hospital and a greater profile in improving local health. Breaking Boundaries articulated much of NHS England’s Five Year Forward View, with subsequent publications, Think Big, Act Now, translating the thinking to practical doing.
- NHS Alliance could be seen as responsible for the existence of NHS England having argued in “Implementing the Vision” for the separation of the organisation that commissioned the health service (the Department of Health) from the one that provided the health service (today NHS England) on the basis that promises from the centre could be realistically costed by those providing the service. NHS Alliance was the first to propose the concept and was punished, for it, when the ministerial foreword removed at six hours’ notice. A few years later the same idea was put forward by the King’s Fund and NHS Confederation and eventually it became official government policy.
- For very many years, NHS Alliance has advocated integration between different aspects of primary care and between primary care, secondary care and social care. Following joint work with both the Nuffield Trust and the King’s Fund, this has now become politically acceptable and part of common political philosophy. Meanwhile, NHS Alliance has further extended this concept of integration of public services with the inclusion, for instance, on its national executive of housing, police and fire services and a recognition of the need to fully utilise all health related agencies from schools to local business.
- NHS Alliance has been the instigator of a wide range of NHS changes from the role of community pharmacy and eye care, social prescribing in general practice to the need for leaders in health creation (health connectors) at local level to radical suggestions such as making each unscheduled hospital admission a significant event, which is more now regarded as common sense.
Michael Dixon: “We have continually tried to redress Government policy that we thought was against the interests of patients and communities. We warned that “Transforming Community Services” would be simply rearranging the furniture and handing primary care commissioning to CCGs has shown that we were right. When PCTs were formed, we advised against the rush from PCGs to PCTs, firstly because we felt that PCGs needed more time to develop their commissioning skills and, secondly, because we were concerned that the PCT model had managers as accountable officers (versus the PCG model that had clinical chairs as accountable officers) and that would extinguish the clinical voice, which indeed it did.
“In recent years, we have spoken out against Section 75 of the Health & Social Care Act not because it encouraged competition or improvement but because it bureaucratised market forces, which would stultify the move from secondary to primary care, which was much needed but which, because of this, was slow to down. We also warned against payment by results, which would move money in the wrong direction, eg, from primary to secondary care, which history has proved that it did.”