Leadership support - Mentoring aid for GP commissioners

Dr Steve Blades points out the advantages to GPs who are unaccustomed to the pressures of lead roles.

Mentoring is generally a long-term and relatively informal relationship with a more experienced colleague (Photograph: JH Lancy)
Mentoring is generally a long-term and relatively informal relationship with a more experienced colleague (Photograph: JH Lancy)

There is widespread recognition that GPs with leading roles in consortia will have significant development needs, but how can they be effectively addressed?

The RCGP Centre for Commissioning has recently produced a Commissioning Competency Framework, available at www.rcgp.org.uk, which identifies what is expected from GPs with differing levels of engagement - for example, as practice lead or as commissioning director.

Role development
A highly effective way to develop the wide range of knowledge, skills and behaviours required for these roles is to work with a coach or mentor. Gaining knowledge about commissioning through educational approaches will be vital. But relying solely on this will be insufficient to foster essential leadership skills.

Coaching and mentoring are similar activities. One definition is that they are learning relationships helping individuals to take on their own development so they can release their potential and achieve results that they value.

Mentoring can be a long-term and relatively informal relationship with a more experienced colleague from a similar professional background. An example in a GP practice context is a partner who mentors an inexperienced sessional GP.

Coaching is often a more formal arrangement that is not necessarily with someone from the same background.

It is increasingly recognised as a having a role in enhancing performance in the workplace.

  • Personalised focus with an agenda set by the client.
  • Deals with real life challenges.
  • Adaptable to the level of the client's experience.
  • Raises self-awareness.
  • Focuses on skills, behaviours and attitudes.
  • Leads to tangible change and results.
  • Provides protected time for reflection.
  • Offers support to isolated leaders.
  • Opportunity for feedback.
  • Confidential.

Non-directive help
The typical approach is non-directive and facilitative and concerned with increasing the quality of thinking on a topic. In reality, the differences between coaching and mentoring are often relatively limited.

I prefer the term 'coach mentoring'. Its benefits are summarised in the top box above.

A typical coach-mentoring programme might involve around six sessions of one to two hours at monthly intervals.

The purpose of the first session is making a 'contract' with the coach mentor. This involves agreeing how the relationship will work and the areas to be focused on during subsequent sessions. This may be informed by the use of questionnaires, feedback from colleagues or psychometric instruments.

My work coaching GPs in leadership roles suggests likely issues for commissioners include time management, influencing clinical behaviour, negotiation with providers and delegating effectively.

During subsequent sessions the areas of focus will be explored with the coach mentor using questions to increase the client's understanding of the subject and self awareness.

Many sessions start with a description of a problem but attention will switch to outcomes and what the client wants to see happen. Each session ends by agreeing what the client needs to do before the next meeting.

Subsequent sessions review progress, explore the topic further or move to another topic chosen by the client.

The final session will include a review of what the client has learned and the impact of this on them. The scenario, below, illustrates a session's benefits.


Consortium lead Dr P outlines difficulties with her relationship with Dr T, one of her fellow consortium board members.

The discussion moves from the evidence that the relationship is poor to her frustrations over what could be happening if the situation improves.

By looking at when they worked well together in the past, Dr P is able to identify that her fast-paced 'big picture' style has led her to clash with Dr T who is very focused on detail and works at a slower pace.

She leaves the session planning to discuss with Dr T how he can make use of his skills within the consortium and is confident about having a discussion on how they can best work together.

She has become more aware of the impact of her style on those around her through the coach mentor's questions and feedback during the session.

Choosing a coach mentor
GP commissioners who want to find a coach mentor have a number of options. Factors to consider about a coach mentor are their background, qualifications, approach, ongoing professional development and supervision. Geographical location is also an issue although sessions can take place on the telephone following an initial face-to-face meeting.

One option is to approach another GP or an NHS manager who has experience of leadership roles and commissioning. This can be relatively easy to arrange on an informal, free basis but disadvantages include the difficulty of protecting time, previous knowledge of each other and the individual's skills as a coach mentor.

The NHS Institute for Innovation and Improvement (www.institute.nhs.uk) and many SHAs and deaneries have invested in training for coach mentors. Contact them for a list.

A professional coach can be accessed via some of the companies offering support to GP consortia and also through coaching websites such as that of the Association for Coaching (www.associationforcoaching.com).

Common Issues
  • Time management between practice and consortia commitments.
  • Influencing clinical behaviour change.
  • Increasing clinical engagement.
  • Effective negotiation with providers.
  • Working effectively with managers.
  • Staying strategic.
  • Developing partnerships.
  • Building an effective team.
  • Delegating effectively.

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