Darzi will call for exceptional management skills

Members of the Institute of Healthcare Management would have welcomed more acknowledgment by Lord Darzi of the past achievements of managers in delivering on tough government targets, says Sue Hodgetts, chief executive of the IHM

Lord Darzi's interim report has prompted lively debate within the NHS in England, none more so than among the members of the 7,000 strong Institute of Healthcare Management.

Some are applauding his vision, while others are asking some rather difficult questions about affordability and the practicality of some of the initial ideas - especially in rural areas. What is certain, though, is that whereas a report from an eminent clinician deemed 'too difficult to implement' might have been kicked into the long grass and forgotten, no such fate awaits the final report from Darzi, now that he is a government minister.

Despite the assertions from health secretary Alan Johnson on appointment that the NHS could expect a period of calm, to settle down and settle in, implementation of Lord Darzi's recommendations, when finally delivered, will mean a further period of reorganisation.

Lord Darzi's recipe for the capital delivered in 'Healthcare for London: A Framework for London', looks certain to be the model he will plump for in the rest of England, if his interim national report is anything to go by.

His proposals call for strategically placed polyclinics, more GP surgeries to collaborate as commissioners, better access and a subtle shifting of healthcare away from big hospitals, which have dominated healthcare delivery for decades.

A straw poll of IHM members suggests that it will be essential to get GP buy-in if these changes are to be introduced successfully. Undoubtedly, there appears some suspicion among the GP fraternity about whether Lord Darzi, an eminent surgeon, really understands their world .

The Royal College of General Practitioners' response to the interim report, ‘A Road Map of the Future of General Practice,’ is promoting its own alternative to polyclinics, an indication, if ever there was one, that GPs, who are now being asked to open surgeries for longer, as well as work together in larger groupings or consortia, will need to be wooed carefully.

IHM practice manager members are acutely aware that much of burden for the change of approach will fall on their shoulders. However, there is very little acknowledgement in the interim report of the importance that managers, whether they work in primary or secondary care, will inevitably need to play if Lord Darzi's vision is to be implemented seamlessly.

One IHM independent sector member's analysis of the interim report suggests that far from seeing a slowing down of private sector involvement in the delivery of the changed model of care signalled by Lord Darzi, there will be a continuing role, which might narrow down the potential pool of independent sector providers willing to take the risks, albeit that contracts may be more far demanding

Another theme that emerged from the IHM member poll is that, while there will be huge challenges for managers, there will also be huge opportunities. One member astutely pointed out that a new breed of manager may be required - one who has all the hard edged management skills, but also the softer ones of the consummate net worker and negotiator who is able to work across new boundaries.

The same analysis suggested that some managers may find themselves working in bigger, more responsible jobs faster than would have been the case had their careers followed the traditional NHS management trajectory. That might mean attracting new talent from outside the NHS, which can only be healthy.

I think he could be right. And this is where the institute will really come into its own. This new breed of manager will need to be equipped and supported to deal with the changes Ara Darzi is seeking to introduce.

The institute will, as always, be developing professional development programmes and support that meet those needs and will be in the best position to disseminate best practice in a fast changing Darzi environment.