GP commissioners are ‘herding a family of cats’, leading doctor claims

Dr Rob Varnam, a GP from inner Manchester, works part-time for the NHS Institute for Innovation and Improvement and is responsible for developing support for GP commissioning consortia. He is also a leading member of the Royal College of General Practitioners.

But this week he said that, while a large number of doctors were supportive of the reforms, the success or failure of individual consortia would depend on managers’ ability to lead colleagues and create a vision.

Speaking at the Innovation Expo 2011, he added: “Clinicians who are experienced at dealing with the NHS will be finding the new climate shocking, and will continue to be shocked. They need to have a completely new mindset. We need good leadership more than we ever have in the NHS.

Clinicians who are experienced at dealing with the NHS will be finding the new climate shocking, and will continue to be shocked

“This is not just business as usual. There are differences and we need to address the challenge of leadership like we have never done before. Relationships will be the bedrock and modus operandi for the future.”

Commenting on the varying nature of the emerging organisations, he added: “Some of these consortia are GP practices which are membership organisations, others are perhaps a network, or a family, or perhaps an organism more than an organisation. It is beginning to look like a herd of cats.

“From scratch, consortia need to create a culture of vision and values. Some are clearly-defined teams, while others are individuals who will work together. Merely leading an organisation will no longer cut it. We have to let people lead hearts and minds, create a vision and inspire trust.”

And he said the best outcomes would result where GPs work across traditional PCT and SHA boundaries.

“We have to remove organisational boundaries and create a culture that works externally as well as internally. It is hard to get real results from clinical pathway redesign if you are only doing it in one area and covering only one area.

It is hard to get real results from clinical pathway redesign if you are only doing it in one area and covering only one area

“One of the opportunities offered by the reforms is that clinicians like working together and have never been comfortable with the gulf between primary and secondary care in recent years. The best outcomes come where clinicians have spread across boundaries.

“It’s weird and it’s different, but it’s quite appealing to many GPs and looks possible when you talk in terms of what a community needs. Bring that into the heart of your thinking and then think about commissioning and what you want to buy differently, or in reduced quantities, or what you want to buy more of. “

Clinicians like working together and have never been comfortable with the gulf between primary and secondary care in recent years

Key to this decision-making process will be close liaison with the public, particularly when consortia have to make tough choices, such as closing services.

Varnam said: “Patients can no longer be on the outside. There’s a requirement to have the patients and public right at the heart. We have not always done that and we need to. It will be one of the best ways we will survive, particularly when decommissioning.

“When you present your reasons for closing something like a hospital to the public, it rarely goes down well. But if you have a vision of how this will work, you are sharing power decisions and responsibilities with patients and the public. It is easier then to do the difficult things you need to do.

If we get the public to understand the needs and shape services, they are more satisfied, the quality goes up and costs seem to go down, which is the perfect triangle

“There is a surprising willingness from the public to get more involved and if we get them to understand the needs and shape services, people are more satisfied, the quality goes up and costs seem to go down, which is the perfect triangle. The triple aim can be achieved when you get patients in at the very beginning.”

General practitioners will also need to embrace QIPP; an agenda many have vocally disagreed with and have, until now, largely avoided.

Varnam said: “The White Paper and the Bill show that QIPP is written into the DNA of the consortia. It is they who are responsible for doing this.

“Many GPs feel QIPP is inherently wrong, and the rest are just puzzled, but this is where service improvements, demand management and safety improvements are going to happen. Consortia will have to own QIPP and have it written through them like a stick of rock.”

Consortia will have to own QIPP and have it written through them like a stick of rock

But GPs will need help, and he said there would be support to fill in gaps in their knowledge, adding: “We need to look at the challenges of leadership, such as training and support and we need to develop skills in a deliberate way, accepting that there are gaps.

“Very few GPs know anything about strategic processes control. They can’t engage their team, or run a strategy. But, when we asked GPs to undertake audits, we set up audit advice groups to help them in the first few months. We might need to do the same for GP commissioning.”