Clinicians as Service Designers? Reflections on current transformation in the UK health services

The British National Health Service (NHS) has been involved in profound transformation to keep pace with, and shape, changes in our society. Innovation has been driven by the necessity to transform old hierarchical and paternalistic models into a modern health system, moving care closer to home, mobilizing and tailoring services to individual patients’ and their carers’ needs through the introduction of radically new services. This paper explores a particular element of ongoing NHS reform: Practice Based Commissioning (PBC). Based on first findings of a research project called “Design in Practice. Change and Flexibility within Health Providers” funded by the EPSRC research centre HACIRIC, the authors argue that PBC formally recognizes important forms of grassroots service design, but also introduces additional challenges. The project is based on case studies within the North West Strategic Health Area (UK), and the study of PBC frameworks and everyday PBC practices in this specific context is explored and contrasted with concurrent efforts to bring service design into the public sector, which are focusing on co-design and experience-based design methodologies. It is suggested that these have the potential to help NHS providers address NHS policy demands to use patient feedback in transforming services (DH, 2009), and the authors reflect on possibilities for potentiation through the application of Service Design methods in this context.