SECURING THE NHS
FOR THE NEXT 75 YEARSThe NHS is the
United Kingdom’s pride but it is also
an institution in crisis.
The Choice spotlights a long-overlooked path forward, one that promises to improve outcomes, reduce costs, reduce clinician burnout, and leave patients feeling heard and understood.
Meet the Hosts
Al Mulley, MD
AUTHOR & CO-HOST
Al Mulley is Professor of Health Policy and Clinical Practice at the Dartmouth Institute and Professor of Medicine at the Geisel School of Medicine at Dartmouth. He previously served as Chief of General Medicine at Massachusetts General Hospital and Harvard where he was responsible for integration of acute and community-based care for nearly 30 years.
He is a founding editor of the text, Primary Care Medicine, and was a founding Director with Jack Wennberg of the Informed Medical Decisions Foundation which led international collaborations in implementation and evaluation of shared decision making.
Together with colleagues at Oxford, Cambridge, UCL, the King’s Fund, the Health Foundation, and the Nuffield Trust, Al has worked on behalf of the NHS for more than 35 years to improve the quality of decisions made at the frontlines of clinical care and at the highest levels of system leadership. He was elected to the US National Academy of Medicine for his leadership in making the distinction between warranted and unwarranted variation in clinical practice and in consequent efforts to raise decision quality in the US, the UK, and globally.
John Lotherington
CO-HOST
John Lotherington is director of the 21st Century Trust since 2000, working in alliance with Salzburg Global Seminar where he had particular responsibility for Salzburg Global's health policy programmes from 2010 to 2020. During that time he led a series of projects in collaboration with the Dartmouth Center for Healthcare Delivery Science around patient engagement and shared decision-making. These built on a seminal Salzburg Statement on Shared Decision Making, an initiative of Glyn Elwyn’s, focused on by the BMJ and still a regular point of reference in health policy discussions around the world. John began his career in history education and has published widely on sixteenth century history. He leads the annual LSE Ideas/Ratiu Forum Teaching of History Programme in Romania. John is also Chair of Cumberland Lodge, a trustee of the Foundation for Democracy and Sustainable Development, and a Fellow of Goodenough College, London, UK.
Credits
AUTHOR & CO-HOST
Al Mulley, MD
CO-HOST
John Lotherington
CONTENT ADVISOR
Margaret Mulley
GUEST CONTRIBUTORS
Nigel Edwards, Muir Gray, Gwyn Bevan, Anna Dixon (MP), Connie Jennings, David Haslam, Angela Coulter, Neil Modha
SCRIPT DEVELOPMENT, MUSIC COMPOSITION, AUDIO PRODUCTION
Chris Trimble
GRAPHIC & WEBSITE DESIGN
FD Designs
Acknowledgements
Over the past decade, the Dartmouth team responsible for The Choice: Securing the NHS for the Next 75 Years had the immense privilege of learning from many NHS colleagues. With publication of The Five Year Forward View in 2014, Dartmouth were invited by NHSE management to coproduce a Place Based Care Learning Network (PBCLN) comprised of frontline teams selected as Multiservice Community Providers (MCP) and Primary and Acute Care Systems (PACS) Vanguards. NHSE colleagues included Samantha Jones, Charlotte Williams, Sukhmeet Panesar, Charles Tallack, Victoria Corbishley, Carl Marsh, and Carolyn Corrigan. Dartmouth are especially grateful to the New Care Models team for introducing us to Paul Corrigan who had been asked to lead the MCP community of practice. He has been generous with his time and support since.
At the launch of the PBCLN in 2016, the Modality GP Partnership was designated as Dartmouth’s host for the PBCLN with Simon Butler, Nick Harding, Gwyn Harris, Naresh Rati, and Vincent Sai participating and/or in supporting roles that continue to this day. Other frontline colleagues included Donal Collins, Keith Darragh, Chris Jones, June Roberts, Richard Smale, and many more. The Dartmouth team that co-produced and delivered that first PBCLN programme included Elliott Fisher, Glyn Elwyn, Gene Nelson, Marge Godfrey, and Chris Trimble. They were supported by other Dartmouth colleagues including Jack Wennberg, David Goodman, and Adam Keller.
In 2017, a second PBCLN was launched in North and East London in partnership with colleagues at UCLPartners including David Fish, James Mountford, Martin Marshall, Mike Roberts, Preeti Sud, Jenny Mooney and Ruth Frost. Frontline colleagues included Dan Weaver, Matthew Cole, John Green, Isabel Hodkinson, and Katie Brennan.
During 2019 Dartmouth had the privilege of working with colleagues at NHS RightCare to adapt the PBCLN to support Primary Care Network (PCN) development. Special thanks go to Rob Wakefield and Nick Harding who had the foresight to commission the programme six months before PCNs were established. Others include Matthew Cripps, Amy Bowen, Lucy Heath, Dawn Chamberlain, Miles Scott, Fiona Ottewell, and Liz Lingard. Dartmouth was subsequently supported by the Black Country Population Health Academy, with Lucy Heath as its founding Director, to deliver the PCN programme to five cohorts reaching 15 of the 30 PCNs in the ICS. Those frontline colleagues are too numerous to name but special thanks go to James Gwilt, Laura Pugh, Samir Mukherjee, Raj Mohindroo, Tapiwa Mtemachani, Ananta Dave, Sally Roberts, and Tehmina Rahman.
Dartmouth also thanks Strategy Unit colleagues Peter Spilsbury, Fraser Battye, Karen Bradley, Lucy Hawkins, David Frith and Steve Wyatt, and Oxford colleagues Muir Gray, Tim Wilson, Anant Jani, and Erica Ison, with whom we co-produced the Midlands Population Health Management programme in 2019. Also in 2019, Dartmouth had the opportunity to participate in the launch of the Cambridge Judge Primary Innovation Academy. We are grateful to Stefan Scholtes, Neil Modha, James Morrow, and Nish Manek for extending the invitation and for carrying that collaboration forward to make the choice to raise decision quality a reality at the frontlines of primary care in England.
More personal thanks are due to many colleagues who supported us in building the foundation for our work with MCPs, PACSs, and PCNs. Chris Ham and Anna Dixon extended the invitation to Al Mulley to serve as the King Fund’s first international visiting fellow, charged with joining up practice variation, shared decision-making, and commissioning. They opened doors to learning from colleagues at the King’s Fund, including Hugh Alderwick, John Appleby, Alf Collins, Steve Field, and many others. Publication of Patients’ Preferences Matter: Stop the Silent Misdiagnosis created more opportunities for learning at NHS England, NHS Scotland, the Nuffield Trust, the Health Foundation, NICE, the i-THRIVE partnership with the Anna Freud National Centre for Children and Families and UCLPartners, and the National Association of Primary Care. We are indebted to Malcolm Grant and Simon Stevens, Gregor Smith and George Crooks, Nigel Edwards and Rebecca Rosen, Jennifer Dixon and Malte Gerhold, David Haslam and Gillian Leng, Peter Fonagy and Anna Moore, and Nav Chana.