Developing a new service

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A complex process, which can take years or even decades.

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  1. Key targets in developing a service in 2007
    • Clinical director
    • Employer's clinical governance
      1. Novel therapies approval
      2. Safety & risk assessments
      3. Equality of access
      4. Interfaces with other parties
    • Employer's budget controllers
    • Commissioners
      • PCT
      • NICE (its on a plate if they are on your side, but there is still lots of footwork)
  2. Key parts of process
    • Case of need
    • Approval for the components
      • Clinic space
      • Personnel
      • Training
      • Equipment
      • Drugs
      • Evaluation
  3. Novel therapies approval, business case, funding
  4. Consider if unsuccessful repeating when opportunity arises
    • Frequent reorganisations can actually work to your advantage
    • Have case already to dust off if critical circumstances change
      1. Central funding initiative
      2. NICE recommendation
      3. Positive clinical trial results in big impact journal
      4. Service now politically correct
  5. Implementation
    • Inflation/Budget firefighting/Purchase/Construction/Recruitment/Training hardly ever complete by agreed implementation date


  1. Gather the evidence
  2. Carefully consider the place and ethics of experimentation, especially if recognised training exists
  3. Marshall the arguments
    • Ensure they are to the point
    • Resource impact must be considered
      1. The cost of employing a dogsbody or two is immense
      2. A new procedure tends to have technology cost
      3. A new drug will always have a cost premium
      4. Most better health outcomes do not return the costs to your own budget
    • Consider all angles
      1. You can put colleagues out of work
      2. You can make more work for colleagues
      3. You could make enemies and indeed might have to
        • If they are more powerful than you (eg unions/politicians) you will have big problems
  4. Make the case
    • Who do you need to convert to the cause ?
    • When do they need to be targeted ?
    • What tailored arguments (spin) for each
  5. Make the presentations
    • Copy format for some other recent successful bids
    • Be prepared for fine tuning and pedantic points
  6. Do not get too disheartened
    • Consider pressure points ie patient groups/publicity
    • Use these correctly in your social/bureaucratic context
  7. Lead the team or appoint a team leader
  8. Implementation
    • May have to be structured and goal prioritised
    • If done prematurely may annoy the powerful
    • If done poorly will annoy everyone
    • Audit/Monitoring/Evaluation for when you are challenged
    • Be prepared for last minute hard work/revision because you forgot to consult someone important who only became aware when you publicity material went out
  9. Exit/Modification strategy
    • Pet services even if high quality can be destroyed by higher authority or other factors such as budget priorities
    • Compromise where key principles not destroyed
    • Give up but be ready to strike when receptive environment occurs
    • In worse case move to more receptive environment
Info bulb.pngIf a service is genuinely a good idea and the health service or your employer will not implement it, there may be a business opportunity, consider setting up that business.