Does The NHS Need 'Council-ing' To Learn To Value Leadership In Primary Care?

Main Category: Primary Care / General Practice
Article Date: 27 Apr 2009 - 3:00 PDT

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While the establishment of the NHS National Leadership Council could add great value, NHS Alliance suggests that its relative lack of primary care input is disappointing and surprising.

Policy rhetoric calls repeatedly for 'a primary care-led NHS'. Primary care is being set the huge task of making NHS commissioning 'world-class'. Yet once again, it looks as if primary care is being forgotten or sidelined. Surely this cannot be the intention?

Primary care is vital to the quality and economic stability of the NHS, especially as it faces financial uncertainty following years of above-inflation growth.

Although there are 152 PCTs in England and around 23,000 GPs, the National Leadership Council has just two 'core members' from primary care: one PCT chief executive and one associate director. Its 'fellows' include one PCT chair and, as the token GP, Royal College of GPs chair Professor Steve Field.

By contrast, the NHS's 117 foundation trusts provide eight of the National Leadership Council: seven chief executives and one chair. The 10 intermediate strategic health authorities provide another three chief executives and one chair.

NHS Alliance believes that leadership is needed at all levels of the NHS hierarchy. Effective leaders are needed throughout organisations - not just at the top. The new model of the NHS, separating commissioning and provision, makes this even more important As it stands, the new Council's membership - short on frontline, team leader-type members - risks continuing in the NHS tradition of retraining the 'top tier' in leadership with same approach; and ignoring team leaders and succession planning through the workforce.

The clinical and managerial team in primary care are at the sharp end of managing the 'risk sink' of the NHS. Their role in commissioning and provision as well as in ensuring and supporting patient choice makes hugely important economic decisions.

Ken Aswani, lead of NHS Alliance PEC chairs' network, said, "90% of NHS care is provided in and by primary care, and policy aims to increase the amount done outside hospitals. As such, we would expect a higher representation - but see more the opposite: less than 10% come from primary care. For this to be successful and credible, it needs substantially more primary care representation".

Claire Old, lead of NHS Alliance commissioning and service improvement network, said, "It's not just GPs who lead in primary care. Practice-based commissioning (PBC) aims to be truly multidisciplinary, yet nursing and allied health professional (AHP) representation from primary care on the National Leadership Council - either front-line clinicians or management leaders - is non-existent. The development of commissioners leading change also needs to be recognised and incorporated as part of the NLC".

NHS Alliance PBC lead Dr David Jenner said, "The composition of the National Leadership Centre appears biased towards secondary care. To have no primary care clinician core member, and just one as a fellow, suggests there is little central perception of the value of primary care and all its professions.

"Primary care must be seen as the solution, not as a problem. World-class commissioning calls for clinical leadership - does it really mean from secondary care?"

Notes

1. NHS Alliance is a collaboration of clinicians, managers and board members who put patients first. It is the independent body that represents NHS primary care. Values-based, it is the only organisation that brings together PCTs with GP practices, clinicians with managers and Board members, and NHS primary care with its patients. The Alliance membership and its national executive are fully multi-professional.

2. Details of the NHS National Leadreship Council can be found here.

Source
NHS Alliance

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