The Scalpel's Blog

11.03.20

Leadership culture in primary care

Words by Dean Royles and Kevan Taylor, who continue their regular contribution to NHE’s blog content. Kevan and Dean work in organisations and systems providing strategic support, advice and development.

Culture in primary care and in secondary care is different. Not better, not worse, just different – Mars and Venus. This is particularly so in leadership culture. If we do not recognise this in the development of Primary Care Networks (PCNs) then we will simply repeat the mistakes of the 1990s.

For those with long memories the merging of the Family Health Service Authorities (FHSAs) with the District Health Authorities (DHAs) simply felt like a takeover by the Districts. A lot of the FHSA culture and “organisational memory” was lost.

The FHSAs had driven an extraordinary and quite rapid expansion of primary care staffing, Health Promotion Clinics and community-orientated primary care. The FHSA leadership culture matched the more entrepreneurial and quicker decision-making culture of those in primary care leadership roles.

Very few senior FHSA leaders went on to be senior leaders in the new merged Health Authorities. The new “professional” management left primary care leadership behind and did not understand the levers and influencers for change.

The most successful healthcare systems integrate clinical, strategic and operational leadership. Just like the healthcare system as a whole, PCNs need to develop their leadership capacity in all three domains. While attention is rightly being focussed on clinical leadership, we also need to invest in strategic and operational leadership to the same scale that we do in the rest of the healthcare system. This is essential if we are to deliver on the ambitions of the NHS Long Term Plan.

Part of primary care’s strength is its diversity. But this can also feel fragmented. It has shorter decision-making lines which means it can respond more quickly than other parts of the healthcare system. But this also reflects the limited support infrastructure in primary care. The rest of the system can and must help, but culture is crucial and it has to be led by primary care. There is a particular role here for the GP Federations – rooted within primary care and primary care led. The rest of the healthcare infrastructure needs to support the Federations in this role.

To be successful, leadership development in primary care needs to address clinical, strategic and operational leadership. It has to address system wide strategy and governance. And it has to make sense to primary care, reflect its strengths and values and feel like primary care.

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