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Answering the call for clinical leadership


12 January 2011

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Clinical leadership will not be a new idea to most readers; it’s been talked about for several years. The case for clinical leadership was put by the Department of Health in the NHS Operating Framework 2006/07 (“leadership across the NHS, and particularly in the new primary care trusts (PCTs), remains the key to delivering improved services to patients”1) and reiterated in the following year in the 2007/08 Framework:

Clinical leadership will not be a new idea to most readers; it’s been talked about for several years. The case for clinical leadership was put by the Department of Health in the NHS Operating Framework 2006/07 (“leadership across the NHS, and particularly in the new primary care trusts (PCTs), remains the key to delivering improved services to patients”1) and reiterated in the following year in the 2007/08 Framework:

Clinical leadership will not be a new idea to most readers; it’s been talked about for several years. The case for clinical leadership was put by the Department of Health in the NHS Operating Framework 2006/07 (“leadership across the NHS, and particularly in the new primary care trusts (PCTs), remains the key to delivering improved services to patients”1) and reiterated in the following year in the 2007/08 Framework:

“It is the very nature of the reforms that improvements must

be owned and delivered by clinicians, managers and other

frontline staff on the ground… It is the responsibility of the NHS community leadership… to engage fully with clinicians, staff, patients and the wider public to communicate and explain the need for change and the potential of the reforms locally to improve services and people’s lives.”(2)

So, how relevant is it to be in the future? And what is the
likely relationship or correlation between clinical leadership
and effective commissioning consortia?

A broader leadership role
In the spotlight of the white paper Equity and Excellence:
Liberating the NHS, the new commissioning consortia that are
to be established will have a remit that far exceeds previous,
often micro-level, commissioning decisions made under
practice-based commissioning.

Crucial local service decisions, both short- and long-term,
are to be passed to clinicians through the consortia. Any
failure of consortia, however measured, has the potential to
reflect poorly on the clinical leadership in that area in ways
highly likely to be detrimental to the health and wellbeing
of the populations of patients they service, as well as making
those accountable for services very uncomfortable indeed.
Clinical leadership in a liberated NHS therefore needs
to be extended to include a blend of patient focus, resource
management and outcome focus in ways that some colleagues
will not recognise.

Consortia are charged with taking on the driving of the
commissioning cycle: from identification of need, through
the securing of services and the performance into outcome assessment and management of those services to drive continuous improvement.

Those with leadership aspirations will find the challenges
that await them are more complex, and require more
networking and influencing skills, than may have previously
been the case. Some will relish the potential to facilitate real
change in the health and wellbeing of their patients through
properly accountable commissioning decisions, while others
will see the whole thing as a burden to be borne or avoided.

If we are to meet our objectives around the right service
in the right place at the right time and “no decision about
me without me”, clinical leadership in effective consortia is
increasingly likely to be about developing close but broadly
based networks of clinicians (and some non-clinicians) of all
types and specialities.

The scope of these relationships and their nature are
going to change markedly, given the increased role of
the local authorities in the delivery of what were formerly
considered NHS services.

Within the National Association of Primary Care, we
recognise this need for a wide configuration of skills and
experience to lead primary care. Our diverse range of leaders
includes not only GPs, but is an inclusive set of experienced
and dedicated clinical and non-clinical individuals that
includes representation from pharmacy, GP registrars,
secondary care, practice management, primary care trust
management and nursing, to name a few. It is the mixture of
skills and leadership qualities within this team that makes
us successful.

An uneven landscape?
It is likely that we have to move through a period of
imbalance. Some areas will be fortunate and find that
they have a surfeit of those clinical leaders who wish to
be involved and have few problems finding enough of
the right skills to deal with both the change to establish a
consortium and its ongoing development and management.
Some will also have natural leaders with the right skills and
temperament to engage with a wide range of interests to
drive what is needed through co-operation and collaboration
across agencies.

Other areas, however, will struggle to find leadership with
the right skills and the inclination to take up the challenge.
Some natural leaders will find their skills or temperament
ill-suited to the collegiate, integrated and broadly based
nature of future commissioning needs.

Some leaders may be reluctant and need to be
encouraged to ensure that their skills are used and their
voices heard. Some strategic thinkers will need support
and assistance in taking on the routine ongoing service
management aspects of the new consortia; and some detail focused leaders will need support and assistance in seeing the bigger picture and ensuring they focus on impact
and outcomes.

Clinical leaders facing a redrawn landscape will therefore
need to balance all of these needs and more.

GP leadership in practice
In summary, to deliver effective consortia clinical leaders will
need to manage many aspects:
Ensure strategic clinical leadership from within the
professions to influence the direction of travel and draw
on the diversity of talents.
• Demand clarity on objectives and priorities for the
consortia – in both operational and strategic matters.
• Encourage reluctant leaders to engage and be prepared
to challenge the status quo to ensure consortia do what is
clinically right for patients and consortia.
• Demand and deliver true multidisciplinary and
multi-agency teams.
• Guard against commissioning and operating agendas
being driven by the most vocal.
• Support and properly evaluate sometimes radical ideas.
• Make sure the patient voice is heard and acted upon.
• Ensure consortia has multi-agency membership and links,
and actively and consistently engage across the professions
in decision-making and operation.
• Work together across professions for commissioning of
services, to ensure services are patient-focused rather than
organisation- or profession-focused.
• Empower and drive a culture where frontline clinicians
from all provider organisations, as well as those from the
consortia hierarchy, contribute both spontaneously and in
response to specific requests for input.
• Work with local professions to identify local leaders to
contribute in information as well as ideas to the planning,
delivery and continuous improvement of services.
• Develop future and current clinical leaders across the
professions to ensure that their local health community
meets local health outcome objectives and needs and
develop their leadership roles further.

Jan has worked in primary care environments with a range

of healthcare professionals for eight years in NHS and private

organisations, and is an experienced commissioner and provider of services. She currently works in PBC management in Yorkshire, is an executive of the NAPC and is also director and part owner of an independent healthcare consultancy.

References
1. The Department of Health. The NHS in England:
The operating framework for 2006/07. London:
DH; 2006. Available from: http://www.dh.gov.
uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_4127117
2. The Department of Health. The NHS in England: operating
framework for 2007-08. London: DH; 2006. Available
from: http://www.dh.gov.uk/en/Publicationsandstatistics/
Publications/PublicationsPolicyAndGuidance/DH_063267

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