Guest editorial Thursday 4th August 2011: The balancing act.

This guest editorial by Dr Steve Kell, chair of Bassetlaw Commissioning Organisation, outlines the balancing act of leadership of clinical commissioning.

As we move towards the brave new world of clinical commissioning (currently correct term in August 2011), the role of the GP leadership is becoming increasingly clear.  And less so.  

Commentator Roy Lilley recently described GP leaders as ‘discussing the leading edge of medicine over a cup of builders and a chocolate Hobnob.’  Unfortunately locally we have had to cancel catering, but the perception is there.  Of course, there is an element of truth to this, and I admit to finding it difficult to hold any meaningful conversation without the support of caffeine.  But the reality of clinical leadership is becoming more obvious.

I used to live in a world where my day was divided into morning and afternoon surgeries, with some visits and lunch ‘a-la-car’.  I had no need for a diary or a smartphone (which is rapidly taking from caffeine as my addiction..)  Then, a PEC role meant regular but relatively infrequent meetings – but I could easily remember every 2nd Tuesday without the need for a pen or iCal.

I now have a PA who is fantastic, and who rules my life.  Time not in surgery is free until proven otherwise.  Meetings spring from nowhere; journeys become shorter on paper than in the actual car; and my phone beeps at me to remind me where to go next.  This may be a brave new world, but it’s not necessarily in our control.  

A welcome to managerial reality
Managers will read this and think ‘so what?  Welcome to reality’.   To me, the ‘so what’ is the challenge facing most GP commissioners at the moment – the balance between clinical and managerial roles.

Fortunately, I have very supportive partners who understand the role and its importance locally.  But the challenge is still significant.

I have heard many say that those who are still smiling don’t understand the role yet.  I disagree.  Perhaps I’m just naïve.  Eternally optimistic.  If I’m truthful, I’m really enjoying the role, the different challenges, AND the fact that someone organises my life.  

The reason to keep on keeping on
Why do we keep doing it?  GPs I speak to do it because they can make a difference locally – from protecting services, to improving pathways, to being able to focus on areas GPs and patients locally feel are important.

We know the issues, we encounter them daily in the consulting room, and we are passionate about local services.  We appreciate the importance of QIPP, the need to be cost-effective, the need to address inequality.

But we also realise we need robust alcohol strategies; that we can improve dementia services; and that we are surrounded by opportunities to improve systems.

’Planning is important, but only if it leads to action and an outcome. The NHS tends simply to plan.’

The key - of course - is delivery. Planning is important, but only if it leads to action and an outcome. The NHS tends simply to plan.

For GPs this can be a struggle – practice meetings tend to lead to outcomes that are often implemented before the next meeting.  Again, it’s about balance, partnership working, and the importance of having good managers to work alongside.

The term ‘clinical commissioners’ is in danger of ignoring the importance of the managers.  If we let it.  

Can we make a difference?  Is that the naivety?  (As Bob would say) Yes we can. The Guardian last month highlighted research by the Cass Business School, which evidenced the benefit of medical leadership.

However it’s not the title that counts, but the person.  Certainly, there is a desire within the Department of Health to ensure we have the opportunity to develop.  Our team has been to numerous networking meetings; had a grilling at the Top Leaders’ Programme; and been ‘media trained’.

The Kings Fund described doctors who became Chief Executives as perceived as ‘keen amateurs’ in 2010 – a perception more prevalent if a clinical role was maintained. What, then, does that mean for GPs?  I know few who would be willing to abandon their time with patients.

I still have a dream where I go to a meeting and come away with more clarity than at the start.  Where we no longer ‘await guidance to tell us if there will be any guidance’.

Yet despite this, we need to deliver for the sake of our patients.  We need to keep improving.  This is no time for a wobble.

Balance is key.