interviews

The importance of early leadership development

NHE talks to Julie Wood, chief executive of NHS Clinical Commissioners (NHSCC), about what needs to be done to develop the next generation of clinical commissioning leaders. David Stevenson reports.

There must be a concerted effort to start leadership development earlier in the careers of clinicians to deliver the next generation of engaged commissioners, NHE has been told. 

Following the publication of the ‘What makes a top clinical commissioning leader?’ report, which was based on a series of interviews with both clinical and managerial CCG leaders, Julie Wood, CEO of NHSCC, said we have to “ensure that it is a role people want to do” and “talk to people much earlier”. But the study, revealed that the majority of CCG leaders from a clinical background said they “fell into clinical leadership”. 

“We should be talking to them much earlier in their career,” said Wood. “We need to be talking to the educationalists about how we build in, if you like, population health management in their learning. 

“We also need to get people understanding what commissioning is about. It is a series of activities that we do, which includes some transactional bits. But it also includes things that, for me, mirror what you are doing on an individual basis as a GP. 

“For example, you are assessing someone’s needs, you are looking at options, you transact something and work out what is happening and whether you need to review and revise. That is commissioning at a micro-level – it is just applying that to a much bigger picture. It is how you bring that connection from what happens in a consulting room to what happens to the population you are responsible for.” 

Joined-up development programme 

The new report, produced by NHSCC and Hunter Healthcare, sets out how current leaders can be supported, and a future generation inspired and encouraged to take up a role in commissioning. 

It suggests that a more joined-up development programme for managers and clinicians leading commissioning organisations is needed, rather than trying to develop each group in isolation, with the ultimate goal to have “managerially intelligent clinicians” and “clinically intelligent managers” who have built an effective working relationship. 

Asked whether there is currently enough of a focus on clinical commissioning leadership, Wood said: “I think it happens, but not necessarily in a really structured way. A lot of the development for leaders in the NHS has been based, historically, on our provider leaders. 

“We are working with NHS England to look at what we need to do to balance that so that we have the right capability building for clinical leaders of the future, be they managers or leaders. It has not been there systematically throughout.” 

In particular, NHSCC is currently seeking support from NHS England to build the chief clinical officers’ network it supported during 2015 into a clinical leaders’ development network, providing some safe space and time to support what CCOs and clinical chairs say is critical to their learning and growing. 

Wood, whose NHS career spans 30 years, added that, going forward, being a clinical leader needs to be seen as equally important as being a ‘jobbing GP’. However, she admitted that when the pressure is on people within primary care “it is difficult to balance the two”.

 “That is why we need to ensure we have a sustainable and transformed general practice going forward,” said Wood, who welcomed NHS England’s recent GP Forward View. “CCGs are now, largely, the commissioners of primary care in all but statute.  And they need to be able to transform the delivery of primary care if it is to play its fundamental role in delivering the Five Year Forward View.” 

She added that in the NHS it is easy to measure the activity and pressures on parts of the system, “but we don’t have the same for primary care, and that is the problem”. 

“So, actually, shining a light on what needs to happen to enable a transformed primary care and GP service is fundamentally important,” said Wood. “From the CCG perspective they have got to have the wear withal to be able to pull their commissioning levers to enable it to happen – part of this is having the resource to do it. We need to be clear about where the resource for transforming general practice comes from, as well as the resource to transform mental health services, which are equally as important and needs to happen.” 

Conflicts of interest 

The latest report also identifies qualities that make a top clinical commissioning leader including resilience, openness, emotional intelligence and being good communicators. 

One area where CCGs have come under pressure in the past is conflicts of interest. NHE asked whether this might be putting some people off pursuing a clinical leadership role. 

“I hope it doesn’t,” she said. “This shouldn’t be seen as an ‘on top of’ role. If people describe clinical commissioning as ‘then I go back to my day job’ it is not valued as a part of your day job. 

“We need to get the mind shift across that this is about portfolio. So your commissioning role is just as important as your GP provider role. What is beautiful and unique about it is that you are using each of those to complement the other.” 

She added that conflicts of interest do exist, but they are manageable. She also suggested that if the situation is neutered too much then the point of clinical involvement will have been lost. 

“This is about bringing clinical insight into making commissioning decisions,” said Wood.

“So if we go too far and say that if you’re a clinician you  can’t be involved with anything clinical commissioning-wise – then what have we done? 

“It is the bit about transaction and procurement. If I’m contracting with myself, clearly that cannot be.” 

Wood added that for people to thrive in clinical leadership roles they need to have the headspace in order to make it happen. 

“It may not necessarily be leading CCGs, it may be leading new models of care,” she said. “Although this report is called what makes a top clinical commissioning leader? It is largely about what makes a top leader in the NHS. If you are leading a new model of care, you need the same sort of attributes. It has wider applicability.” 

Discussing new models of care and sustainability and transformation plans (STPs), Wood said that clinical leadership, engagement and ownership, not just of GPs through member practices and CCGs, but the whole clinical community across a footprint is fundamentally important. 

“That is how we are going to drive the change,” she said. “STPs are the process by which CCGs and health and care systems start to work much more collaboratively about how they close the gaps.”

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