GPs are being pushed hard to take on substantial leadership roles: they are at the heart of commissioning and in the spotlight as leaders. We talked to GP leaders about the challenges they face and the support they need.
They identified the most critical roles as leadership of clinical commissioning groups (CCGs) and representative and negotiating groups, for example LMCs, and leadership within their own practice.
'If general practice is to survive then GPs have to learn the skills and techniques needed to run medium-sized businesses' (senior GP, east England).
Much of the leadership work for GPs entails a move from clinical work to taking on responsibility for strategic, management and financial decisions. As a GP leader in London reflected, you 'have to know how to delegate - how to trust - how to get feedback'.
As leaders it is expected that GPs will still have a clear grasp of what is happening on the ground. A CCG chair we spoke to felt it crucial to remain in clinical practice: 'Our peers want to know we are still connected to general practice ... I want to maintain my credibility.'
Many experienced GPs find leadership thrust upon them. The leadership demands of the CCG authorisation process are substantial and we suspect GP leaders will find themselves wondering if they can make the standard.
For many doctors, there is a real challenge in moving beyond the consulting room: from the caring/listening role to the managing/directing role.
A problem is that much of the leadership thinking focuses on being hierarchical whereas GPs must learn to use a broader, more collaborative range of leadership skills and still make decisions while taking their colleagues with them.
GPs we spoke to reflected on the often difficult dynamics across CCGs and in GP partnerships; managing and leading intelligent and challenging peers is not for the faint-hearted. Time is a serious constraint for GPs - a busy clinical caseload, a busy practice, driving business strategy, understanding finances and leading peers is a challenging mix, even for the most able.
Our proposition is that coaching can help enormously. Like becoming the CEO of a large organisation, becoming the chair of a CCG or indeed the managing partner of a large practice can be lonely.
Making decisions about financial and staffing issues, handling complaints and dealing with the media can make individuals feel very exposed.
In CCGs this is being done at high speed. There is usually no one it is safe to confide in, so a coach can provide much-needed support and an external view of what is happening, with guaranteed confidentiality.
The need for support is demonstrated by The National Leadership Council and others offering coaching and development programmes to GP leaders: 'On taking on a leadership role I was bombarded with stuff from the SHA' (senior GP, east England).
GPs who accessed coaching felt it was very worthwhile: 'The new agenda for GPs definitely means they need coaching' (CCG board member).
'Coaching provides me with a safe place to talk through the challenges of leading a CCG' (CCG chair, south of England).
'My coach challenged me about my assumptions and helped me develop courage to tackle issues. Our sessions improved my assertiveness as a leader' (GP leader, London).
'Many GPs increasingly understand that they need a business model and that old-fashioned partnerships will no longer work. Coaching can help make this transition' (senior GP, London).
We believe properly contracted leadership coaching provides a safe haven for GP leaders to share difficult issues and work out strategies while retaining their energy, sanity and, critically, relationships with fellow GPs.
Many mentioned practical issues where they had used their leadership coach as a sounding board, for example practising how they might address a difficult colleague or be a more resolute negotiator. They felt unable to talk to colleagues so working with a coach was crucial to their success and wellbeing as GP leaders.
'It gave me private space to think ahead, to work things out' (managing partner, London).
'I really value the space to think that coaching offers' (CCG chair, south of England).
Leadership coaching can offer many benefits to GPs taking on leadership roles within CCGs and general practice. Those we interviewed felt it was a good investment because coaching provided space, helped them manage their work-life balance and specifically eased the transition from a clinical to a leadership role, as well as combining the two.
We conclude that given the uncertain future facing GPs, accessing leadership coaching is a sound basis for preparation.
'I plan to offer access to coaching to all CCG board members to help support them in their new roles' (CCG chair, south of England).
- Dr Goodburn is a GP in London. She has twice been managing partner of her large inner city practice and has experienced coaching.
- Isobel Gowan is a leadership coach working with a range of clients, including GPs and hospital doctors. Isobel@isobelgowan.co.uk