DoH guidance notes cannot create GP commissioning consortia. They will come through the hard work of some enthusiastic GPs developing their own leadership skills and working with their fellow GPs to find out how commissioning can improve the lives of their patients.
Over the past two years, the only reason the Cumbrian GP commissioning localities have been successful is because hundreds of conversations have taken place between the lead GPs and their colleagues about how commissioning could improve patient outcomes.
This detailed process of discussion and leadership takes time and effort. My pamphlet called Practice makes perfect (available at www.demos.co.uk) shows how this has developed in Cumbria.
There is a danger that the government, PCTs and SHAs will short cut this development work by suggesting necessary organisational charts before GPs themselves have talked and created their own vision.
Along with most NHS managers, I have spent my working life in large organisations. I work in buildings with several floors of open plan offices.
Compared with this, most GPs have spent their working lives helping to run small organisations. For them, the idea that they need a floor full of managers to commission healthcare is bizarre.
Consortia will gain allegiance from their GPs if three things happen.
First, you need a number of GPs who really want to develop commissioning and lead that process. Few GPs simply 'know' how to lead a commissioning organisation. They need to spend time and effort on describing how this might impact on their own and colleagues' practices.
Space to think
Second, all the other GPs need to talk frequently with these leaders about what commissioning might mean. These conversations generally start with a puzzled audience. The lead GPs must give their colleagues the space to think through what is important to them.
In one practice it may be about how much better referrals could be. In others it may be mental health or diabetes, while in most places, a major concern is not getting timely information about patients after they have been referred. Most GPs feel that better commissioning will mean better and more controlled referrals.This takes time. Short cut it and GPs can feel pushed around.
Third, a transfer of real power and resource has to happen alongside this development work. GPs will only learn what this can achieve by doing it.
Practical people learn by doing practical things for real. This policy will not work if the change is expected across the country in one day.
- Paul Corrigan is a management consultant and former special adviser to Tony Blair. More at www.pauldcorrigan.com
