Viewpoint: Involving other professions in commissioning

Changes to the Health Bill mean nurses, secondary care doctors and lay people all have a part to play in commissioning. Dr Chris Mimnagh explains how GP commissioners can develop a good working relationship with different professional groups.

Dr Chris Mimnagh: consortia leaders can take simple steps to build trust (Photograph: Pete Hill)
Dr Chris Mimnagh: consortia leaders can take simple steps to build trust (Photograph: Pete Hill)

One of the features to emerge from the pause in the Health Bill's progress was the placement of clinicians on consortia (or clinical commissioning groups') boards whose background is not general practice, or even medicine.

For a clinical commissioning group to function, it will be necessary for these new clinicians to trust that the group and its leaders are on track doing ‘the right thing’ for the population. In a similar way, all commissioning group members will need to trust their leaders, but the gulf that has grown between secondary care clinicians and the emerging leadership of general practice is huge and requires specific attention.

Contrary to popular belief, trust is not just earned, it can be cultivated. This should not be a cynical ploy, but an honest attempt at improving the relationships and shared values that contribute to trust between clinicians from different backgrounds. 

Consortia leaders can take four practical steps to build trust with their constituent members and local secondary care clinicians.

1. Understand the worry
GPs know that our personal incomes are on the line with much of the new commissioning agenda. Equally, all hospitals and their staff are becoming stressed, with talk of closures and cuts being bandied freely about by the media. If you can recognise, and be seen to recognise, their concerns, people will give consideration to your plans.

2. Be transparent
Clarity of the agenda from the start means that clinicians have the option to engage or not. If the agenda is quality based, there may be an easier ride. If the agenda is purely about money, make that clear from the start, but remember if you are going to dissipate any concerns, you will need to have some mitigation for them.

3. Be consistent
Changing the strategy or direction will make trust evaporate at once. If there needs to be a change in direction, or a plan does not come to fruition, get out there and explain clearly why this has happened.

4. Develop relationships
Taking time to communicate and understand others' concerns on a personal and professional level is essential. All organisations are the sum of their staff and talking about trust closures and service shifts may be key to the new commissioning agenda, but colleagues may perceive these changes as the onset of personal financial insecurity or good friends and workmates becoming unemployed. If you can demonstrate concern and understanding for their position, they are more likely to trust that your actions will have the right outcome for the right reasons.  

These steps will not always deliver trust; colleagues may be too damaged by previous experience to believe that a new direction for commissioning is possible. They may fear their ability to exert any influence is limited and that they lack the structure to influence the commissioning agenda. However, ignoring the trust question and pushing on with strategy alone is not a recipe for success. Trust me, I’m a doctor.


Dr Chris Mimnagh is a GP in Kirkby, Merseyside, www.clinicalcreativity.com

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