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Why every PCT and SHA should have at least one GP on their board

GPs have the opportunity to shape the NHS of the future – and we have a responsibility to ensure that they step up to the plate and seize that opportunity, says Professor Steve Field

As leader of the Royal College of General Practitioners, I know that my colleagues across the country are already seen as clinical leaders in their practices and in their local communities. GPs often hold a hard-won place at the heart of many communities, which stands as testament to the value their patients place upon the work they do. Yet many lack the confidence to translate this clinical and societal leadership into the broader health service arena. As a result, many excellent GPs with exemplary leadership skills do not put themselves forward for top roles in the NHS locally, regionally and nationally.

I attribute this in some part to the fact that when you see medical leadership, you often see the consultant rather than the GP and indeed primary care representation and leadership is often viewed as tokenism

For too long, GPs have been viewed as the poor relation of the specialties – politicians speak primarily about hospitals and secondary care, which reinforces the view that this is where leadership comes from. This attitude has a negative personal affect on those GPs who wish to pursue leadership and feel that it is outside their reach and a far wider effect on the NHS as a whole as we are missing out on future stars of leadership coming forward.

In addition, we must also be aware of the wider primary care team including practice nurses, practice managers and health visitors, for whom often the opportunities to develop their leadership skills are fewer. I support developing leaders in and from primary care, irrespective of their clinical background. The RCGP’s General Practice Foundation, in partnership with the Royal College of Nursing and others, is working to achieve this end.

The relationship between primary and secondary care is changing but our secondary care colleagues must give more recognition not only to the importance of primary care and primary care leadership but also to the clinical leadership already demonstrated by today’s GPs. Ultimately, it is only through partnership between primary and secondary care that we can provide the best possible care for our patients. The patient experience must not be dependent on the status of the relationship between primary and secondary care givers.

As well as delivering continuity of care, partnership working means that we develop greater professionalism, skills and understanding through training, education, sharing best practice and continuous professional development. Ultimately, I believe that we should be delivering care focussed on the needs of our patients in a much more integrated way. Teams without Walls, our RCGP initiative with the Royal College of Physicians and others, is leading the way.

The issue of GP leadership came to the fore in England during High Quality Care for All, Lord Darzi’s review of the NHS. The RCGP raised concerns over the lack of input from GPs into regional workstream and on strategic health authority boards. We championed the need for greater GP input and demonstrable leadership. We were concerned that at the time only a minority of PCTs had a GP as medical director and a tinier number still had a GP as chief executive. It begged the question of how top jobs could be made more attractive to entrepreneurial GPs.

I believe that every PCT and SHA should have at least one GP on their board. But the problem is that many GPs do not have either the relevant experience or the confidence to put themselves forward for these positions or, if they do, they find themselves unsupported. The RCGP is committed to promoting clinical leadership both in encouraging GPs who wish to pursue leadership roles and supporting them once they are in these positions.

An example of our commitment is our recent collaboration with the British Association of Medical Managers to launch a new initiative to tackle management and leadership challenges in primary care. Our Joint Board for Medical Managers in Primary Care, chaired by RCGP Fellow and National Clinical Director of Primary Care Dr David Colin-Thomé, is designed to act as a national network supporting medical directors and newly-created responsible officers for revalidation, producing relevant training and development opportunities for those interested in primary care management and in stepping up to leadership.

The initiative is already proving to be a huge success. Nearly 40 representatives from PCTs around the country attended the first meeting – held at the College – where it was agreed that that one of the board’s most pressing tasks would be to define and get consensus around the actual role of PCT medical director, since it was open to different interpretation by different trusts. Through definition, we can dispel the intimidation that puts many GPs off going for these positions.

In addition, BAMMbino, BAMM’s junior doctor sub-division, has branched out into primary care by establishing a primary care working group to organise events and resources for GP trainees interested in management.

The emerging opportunities for GPs as leaders of clinical services means that it is really important that all GPs are able to develop their skills throughout their careers, and this needs to be equitable. In the past the 'old boys network' tended to recruit people of the same class, colour and culture – in today's diverse society, it is crucial that all of us become confident in our own abilities to contribute and act as leaders. To do this, it is important that those who are interested in clinical management and leadership are aware of their options as early in their careers as possible.

The RCGP does this by including leadership skills in its membership curriculum, by running CPD events across its faculties, by offering personal mentoring and guidance for those interested in representing the College at all levels, and in 'high calibre' training in the College’s own leadership programme. Every year, through this programme, we equip GPs with the skills and political ‘savvy’ to influence within their own communities and local areas.

But it is not enough to simply tell GPs that these opportunities are out there should they be willing to look for them – we must also provide practical, tangible encouragement through mentoring and work shadowing. I regularly invite young doctors to spend ‘a day in the life of the RCGP chairman’, giving them the opportunity to experience first hand the practicalities of leadership and so far the feedback has been resoundingly positive.

Beyond this, GPs need role models to inspire their leadership aspirations. As part of our leadership programme, a ‘blue ribbon’ panel of leading figures in the business and medical world has been assembled in order to contribute to the programme and provide participants with valuable insight into their worlds.

While it is true that primary care trusts need to be more active in encouraging GPs to come forward for leadership roles – it is equally important that GPs have the confidence to put themselves into the frame for top jobs. We can only do this by creating an environment of encouragement and support that bridges the clinical divide. The College cannot achieve this in isolation which is why our collaboration with BAMM is so valuable.

To be medical director of a PCT, for instance is an incredible opportunity for a GP in terms of leadership and what we need is to find ways of encouraging more GPs to take on this role. But it is a two-way street – while the RCGP must support and encourage GPs in taking these roles, GPs themselves must also have confidence in their abilities outside the surgery, and to stand up as leaders rather than managers.

The profession faces new challenges every day, challenges such as obesity and an ageing population, with their respective co-morbidities and complex needs and to face them head on we need to evolve and, more importantly, we need new, ambitious models of care for the future.

Whichever party is elected this year will be working under increasing financial pressures, which will require us to improve productivity by becoming more actively involved in commissioning, by working smarter in our multi-professional teams and by working with specialist colleagues out in primary care so that patients can receive even higher quality of care closer to where they live.

GPs know what their patients want and know how to deliver services not only effectively, but also cost effectively. We know that commissioning will be the biggest show in town and GPs must be allowed to flex their skills and influence to make sure that it is carried out effectively to the benefit of the patient.

GP federations – groups of GP practices working in partnership to provide increased services to their communities – are providing GPs with the opportunity to work together and to take greater control of the services offered to their patients and communities. It is encouraging to see so many of them taking off around the country, and to see GPs empowering themselves by taking more active roles in commissioning services.

The greatest challenge of all is to provide the proper structure and support for our medical leaders. If we can encourage primary care clinicians to step out of their clinical comfort zones into positions of leadership and support them once they are there, we will be well equipped to face the challenges of the future and ensure that our patients continue to receive excellent care long into the future.

Professor Steve Field is chairman of the RCGP

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