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.