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Guest editorial Monday 23 May 2011: Between jobs – a clinician turning leader

This guest editorial from Dr Steve Kell GP, and Chair, Bassetlaw Commissioning Organisation, looks at the leadership role for clinicians, and how to develop it, individually and organisationally.

In my previous article, I discussed the importance the importance of building the right team for a GP Consortium, of having ‘the right people on the bus’ and people in the ‘right seats’.

Leadership will be a key issue for many local areas: who should lead consortia, and ‘drive the bus’ through these times of uncertainty and financial challenge?  If the reforms are to achieve their original aim – of increasing clinical responsibility – then for most, this will mean leaders being clinicians and having responsibility as well as accountability.  

There may be some resistance to this. Many clinicians suggest that we as a group lack management training; lack the experience; should ‘stick to seeing patients’.

To many managers, the old system worked - and ‘letting go’ will be an issue.  How many areas can genuinely say, for example, that clinical leadership under the current system achieved its potential? GP practice-based commissioning (PBC) worked well for some; but for most, it simply highlighted the challenge of making clinical input count in a system set up to encourage bureaucracy and performance management, rather than innovation and pragmatism.

In opposition, Alan Milburn attacked managers as ‘men in grey suits.’  As I write this, I am a GP who seems to have taken to wearing grey suits, a tie every day and checking whether my shoes are polished. I’ve noticed other GPCC leads starting to do the same.

I described myself in a meeting last week as ‘between jobs’ – half GP, half manager.  I ‘brainstorm’, ‘plan’, ‘network’, and last week caught myself ‘horizon scanning.’  I tweet (on Twitter, that is); watch the news for NHS stories; and occasionally catch a train to London. However, I also look forward to surgeries more than ever, and to the ‘real’ challenges that patients bring.

Developing leadership skills
There are key challenges for clinical leaders in the New World – maintaining clinical time; constantly changing roles; and accepting what we are good at and not so good at.  One could argue that the generalist nature of primary care equips us for this, but there needs to be a conscious acceptance that we need to work alongside ‘managers’ to deliver the best results, and that a symbiotic relationship is needed for results.

So how do we develop as leaders?  There are many courses promising personal development and ‘leadership skills.’  I have ‘been through’ the NHS Top Leaders ‘diagnostic’ (is there something to diagnose?) with the Hay Group, and found the 360-degree feedback and interviews challenging but extremely useful.  It is never comfortable being challenged on personal attributes, but I genuinely feel I have made improvements as a result of the experience.

Last week I referenced a book by Jim Collins - ‘Good to Great’.  Leadership is a key theme for Collins, and he described a ‘Level Five leader’ as one of the attributes that could make an organisation ‘great’.

What is the key Level Five attribute? Selflessness, and an overwhelming desire to ensure the organisation succeeds.

To many GPs, this is the reason for working so hard on ensuring a successful transition – there is a lot at stake both for the NHS and patients, and we are passionate about ensuring services are safe, high quality and sustainable, as well as being cost effective. It is this desire that makes us drive to so many meetings and (for me, anyway) work harder than I have done since house officer days.  

The King’s Fund has recently published an excellent review of ‘Leadership and management in the NHS’.  It highlights the importance of not demonising managers, and of avoiding a ‘heroic leader’ without the development of others.  Interestingly, the ‘No more heroes’ banner is proudly presented as part of the title of the report.

Certainly it is important to develop as individuals and as teams.  In Bassetlaw, we have an organisational development plan with this aim, and the executive team have undergone one-to-one interviews to identify key themes. We have learned over the past year that we can all lead and contribute, and that shared vision is the key to moving forward.  

If politicians sometimes demonise managers, then clinicians often do as well. I hope we are becoming wiser, but I was in a meeting (elsewhere) last week where a GP told those present that NHS managers “weren’t well trained and knew nothing about management theory”. Adversarial relationships of this kind won’t work; won’t succeed; and will not benefit patients or services.

So will clinical leadership make a difference? I hope so. If we can avoid the urge to increase performance management and bureaucracy, and encourage a review of systems (‘what is this meeting for?’) and innovation, then we may be able to enable positive change.

The relationship between clinicians and managers could be a long and happy one, if we trust each other.