GP-led NHS - Top tips on workforce issues

What roles will you and practice team take on when GP commissioning starts?

Helen Northall: forward-thinking practices must start planning now (Photograph: Primary Care Commissioning CIC)

The need for GP consortia to build from the practice upwards is a consistent theme from the government.

GP commissioning raises a number of potential issues for practice teams in terms of playing an active role in GP-led commissioning and as providers responding to the new commissioning environment.

Statutory bodies
There will be a clear separation of organisations and duties. Practices will still be businesses in their own right, responding to procurement processes to gain additional services beyond the core primary medical care contract. Consortia will be statutory bodies with new roles, responsibilities and accountabilities.

But the boundaries will blur around the roles of individuals. While commissioning organisations will undoubtedly employ some of today's PCT managers, the government hopes to see clinicians, and not just GPs, take a strong lead. If this does not happen, the fear is that commissioning consortia will be PCTs by another name.

Clinicians must be resourced
Practice-based commissioning has been more of a hobby than a real job for many of the GPs involved: something to be done in the evening and in protected time. For GP commissioning to work, clinicians need to be resourced to dedicate some of their time to develop and deliver their new roles.

If GPs, practice nurses, practice managers, allied health professionals and others are going to play active roles in commissioning, there will be implications both in terms of the roles they move into and the gaps they leave behind.

It might seem early to think about workforce planning when there are still questions to be answered about the organisational structure of commissioning consortia and the funding available to them.

But forward-thinking practices must start planning now. Even those that do not yet know how big a part they will play in commissioning need to start framing questions about how their role as providers might change in the new environment.

Seven top tips on workforce issues at gp practices

Undertake a skills and aspirations audit:

  • What skills do staff currently have to support commissioning? Do any want to develop skills and knowledge?
  • Consider likely staff turnover and identify vital skills that may be lost and which will need to be replaced.
  • What capacity (service provision) issues will arise?
  • Are all the implications clear to the management team?


Use the skills audit and practice meetings to help you to put together a plan:

  • Where are you on the provider-commissioner scale, and where do you want to be?
  • Will your practice be driving or taking a back seat in the GP consortium?
  • Who do you want to work with and what skills do they have?
  • Is there consensus among GP partners and staff?
  • Identify the opportunities for partners and staff and the implications. What will the impact be on skill mix, recruitment issues and working with other professionals inside and outside the practice?


Work out what skills you have and will need:

  • Negotiation.
  • Need assessment and planning.
  • Service change management - including stakeholder consultation, leadership, improvement science skills, implementation, analytical and review skills.
  • Information management.
  • Decommissioning services - the reality of achieving more with less.
  • Making other hard decisions about where to commit resources.


Will effective communication be a problem?

  • Media relations.
  • Working with patients' representative groups.
  • Explaining hard decisions to colleagues, patients and the public.


Consider how you want to develop as a provider:

  • GP-led commissioning is likely to create the opportunity for more primary and community-based provision, so the practice may be able to bid to provide additional services to patients.
  • Have you got a shared vision in the practice of the services you will wish to bid for?
  • What skills do you need to respond to procurement processes and prove to the commissioner you can deliver the services required?
  • What alliances will you need to make with other providers?


The practice will need to work with the PCT and other organisations:

  • Identify individuals who will work with you today and who you want to work with tomorrow.
  • Discuss how to collaborate more effectively even though funding issues may take time to resolve.
  • Could other professionals help to meet clinical capacity shortages?
  • For commissioning, what needs assessment information and use of service data do others in the health community have?
  • What could GPs stop doing or do less of to free up their time for more strategic roles?


Review your training plan in the light of new demands on your practice:

  • Can you train existing staff?
  • Will you need to recruit new staff?
  • Do you have a succession plan?
  • How do your income projections square with your future staffing needs?
  • Where are your future staff and who is training them?
  • Join online healthcare networks and ask for help on sourcing job descriptions, gaining feedback on where to get good training, identifying free resources available and finding out where you can access shared learning and case studies.
  • Encourage and empower the whole team to lead on an area of commissioning and provider work.
  • Make leadership practical: organise training for the skills people need to deliver live projects. Coach rather than teach.

Helen Northall is chief executive of Primary Care Commissioning CIC,

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