Viewpoint: GP commissioners and local authorities

Regina Shakespeare has advice on working with local authorities' health overview and scrutiny committees.

Regina Shakespeare: Local authorities influence seems likely to become stronger
Regina Shakespeare: Local authorities influence seems likely to become stronger

Over 130 local authorities (LAs) have been identified as early implementers of the Health and Social Care Bill reforms, and are creating shadow health and wellbeing boards.

Given that the NHS Future Forum listening exercise just ended and was at least partly engineered by unhappy Liberal Democrats who have championed LA control over the NHS, LAs’ influence seems likely to become stronger.

As clinical commissioners engage with local QIPP plans, conscious of the scale of the £20bn NHS savings challenge, LAs anticipate a much less generous financial settlement.

So the level of interest in LA chambers in what the NHS is doing – and who is pulling the strings - has arguably never been higher.

LAs’ health overview and scrutiny committees (HOSCs) are used to invite chairs, chief executives and senior managers to encounters unlike anything in the NHS culture. As many of these senior NHS managers have found, the resulting dialogue can be quite different from their discussions with local government senior managers. 

Now GP consortia are experiencing that challenge as they begin to represent the future decision makers of the NHS in front of HOSCs.

Dr Joanne Medhurst, a lead GP in Bexley, one of the earliest pathfinders, found early experiences during a major local hospital consultation a challenge.

Two years and a big investment of time later she comments: ‘We’ve made a big effort to get to know the local councillors with great success. The informal meetings in particular have allowed us to explain issues away from the setting of a public meeting, where councillors clearly have to demonstrate their effectiveness in responding to their constituents’ concerns.

They certainly keep us on our toes and the experience has made us more open.’

Being mindful of councillors’ needs rather than just NHS concerns is a theme confirmed by Margaret Stockham, managing director of Partners in Practice, which works extensively with clinical commissioners.

She agrees it is essential to understand the link between councillors and residents: ‘Councillors might want to explore any issue raised as concerns by local people. Typically these may not feature on your agenda at all - so be prepared for questions coming from left field about a new drug or even custom and practice that you take for granted.

‘Being helpful and constructive will always help build your credibility and help you in days to come. Lastly, be honest and if you don’t know the answer don’t make it up, but agree to find out and get back to them.’

One thing that GPs and local politicians have in common though is an in-depth understanding of their locality and intense daily interaction with those who live there, and this can be enormously helpful in engaging with councillors who want to explore exactly what kind of changes their residents and voters will experience as clinically led commissioning becomes a reality.

So how do you achieve credibility with your HOSC and future LA partners?

Lynelle Hales, joint director of strategic commissioning at Islington PCT and Islington Council has the following tips:

  • Don’t wait to be asked but offer to give a presentation enabling you to guide the conversation and highlight the key points you want to make. Keep your presentation to under five minutes and be as clear and concise as possible.
  • Offer to have a pre-meeting with the HOSC chair to talk through key issues. This will enable you to find out what some of the members’ concerns are likely to be so you can be prepared for questions at the meeting.
  • Find out who else usually attends. The executive member for health is often a regular and can prove a great ally if briefed prior to the meeting.
  • Remember you are leading change, not necessarily managing it. Bringing the appropriate healthcare manager with you can help handle the detail and increase committee confidence in the changes.
  • Be prepared for the unexpected question. With known local hot topics, work out your key message and potential answer in advance, but do not make guesses.
  • There is much to be gained by a constructive approach and an upfront commitment of time – these are some of your most important future stakeholders.
  • Do not use a lot of impenetrable clinical language to avoid difficult questions or throw questioners off their track. Speak plainly and be upfront. 

Regina Shakespeare, PCC associate and former chief executive of Luton Teaching PCT. Click here for upcoming PCC events

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