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A tall order

As primary care in Britain stands on the brink of the largest leadership shake-up for a decade, National Health Executive asks Dr Mike Burrows what kind of leadership PCTs will have to provide to ensure that the transfer of responsibility to GP consortia goes as smoothly as possible

Whether they want it or not, GPs have been given the opportunity to provide that leadership through the new commissioning powers given to them by Andrew Lansley.

But do GPs have the skills or inclination to take on such a huge responsibility?

NHS Salford chief executive Dr Mike Burrows believes it will vary across consortia.

“There are already some mature and established consortia which - although they might not be able to completely hit the ground running - are almost there in terms of their ability to deliver.

“Then, at the other end of the spectrum there will be some consortia which, for a variety of reasons (and some not of their own making), will still be in their relative infancy. It is these which will require the most development and this will be a huge task for them.

“From the consortia’s point of view, some have been very positive and raring to go, whereas some have been a little more cautious. It is the latter group which I believe have taken the most sensible approach because whilst we now have the top level policy, the devil, as ever, will be in the detail. Therefore, I think that the GP consortia which are a little more cautious probably have a bit more wisdom.”

This redistribution of power is going to be incredibly complicated and will require a high level of leadership from both sides.

“In terms of the GP consortia, effective leadership skills will be required in the establishment of organisations and also in creating a single focus of leadership. Although there are some very established consortia, the next stage of their journey - to statutory organisation status - is going to be one which is tremendously challenging. We might even see a change in the leaders of some GPs deciding that they do not want to provide that leadership for the next stage of the journey and new leaders have to emerge.

“This could pose a major challenge and I think that, with regards to knowledge acquisition, there will be a huge range of responsibilities which they will have to gain a good understanding of fairly rapidly. I feel that one of the key characteristics of successful primary care trusts has been their ability to work with other partners within the health economy, but particularly with local government.

“This is an area which many GPs won’t be familiar with and so will prove to be a key leadership development requirement in how to manage those relationships effectively. That means being able to work through differences with those partners in order to develop strong and long lasting relationships.

“I think in terms of the PCTs, it is going to be a completely different set of leadership skills which are required, particularly in working with a group of staff who are likely to feel a little bit battered and bruised by the whole affair.

For the next two years, PCT managers are going to have to up their game considerably whilst working in the knowledge that the organisation which they work for is going to be dissolved, making the maintenance of staff morale a real challenge. This will be compounded by some very challenging management cost reductions.

“I’ve spoken to the staff in my organisation a number of times now to impress on them how much I appreciate that we have done some absolutely superb work over the last eight years and that we want to leave a legacy to be proud of. Additionally, it is in the collective interest of staff if they do work really hard over the next two years because it will go some way to securing further employment once the PCT is dissolved.

“Believe me, it is not the easiest of messages to sell to people and it’s providing the PCT leadership with challenges on a scale which we have never experienced before. This includes keeping our staff in the picture as much as we can and trying to relay information face to face as much as possible.

“The behaviour of PCT leaders over the next two years will have to be of an incredibly high standard in order to facilitate a handover to the GP consortia which is as smooth and safe as possible. It’s a fairly tall order actually.”

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