News and Comment

Challenges for clinical health leaders in changing times

Tuesday 29 November 2011


As the NHS Alliance conference begins in Manchester, participants working in primary care and partner organisations will no doubt be keen to hear from leading practitioners, politicians and commentators. We can expect discussion to be wide-ranging, informative and occasionally impassioned as people debate the future health service and their roles within it.


There is obviously a substantial agenda – so many changes to implement and so little time to do it all – and many clinicians and managers are working with great professional commitment to ensure, as best they can, that new arrangements are put in place that will deliver against local and national challenges for health and social care.

But sitting within this demanding agenda are differing assumptions about the forms of leadership that will in practice bring about desirable and financially-necessary changes.

A new world of clinical commissioning

We meet many clinical leaders who are getting to grips with the new world of clinical commissioning and, in many cases, the substantial financial challenges that come with it. But in the context of these far–reaching, system-wide changes it is striking how many of the GP leaders we talk to first express concerns about maintaining and improving service quality, quickly followed by concerns about how they can best engage colleagues in other practices and encourage them to get involved in creating positive change. For these processes to work effectively they have to be done in ways that are broadly acceptable. The leadership development agenda may appear predictable, but clinicians tell us it presents them with challenges as well as opportunities.

Consider the fit between the need for complex problem solving, which undoubtedly describes the current situation, and appropriate leadership styles. GPs and other clinical leaders are generally used to working relationships characterised by collegiality, even when this includes a hierarchical dimension.

Equally they are used to drawing on evidence, making decisions on this basis, and assuming that most colleagues most of the time share their commitment to patients and quality service. These assumptions about the purposes of leadership create a web of connection, even at times when individuals may disagree on particular issues. Considering stakeholders’ goals through inclusive leadership is a characteristic of good practice, exemplified through the National Leadership Council’s clinical commissioning group (CCG) development framework.

In understanding and rhetoric at least it appears the need to move beyond old style ‘out-in-front, one-person-at-a-time’ leadership is fully endorsed. But the current need to ‘drive changes through’ at speed and with perhaps less than ideal levels of consultation threatens to reinforce a leadership style that some aspects of the reforms ostensibly set out to minimise.

The forthcoming debates in Manchester among the primary care community are an excellent opportunity to consider how high-quality and inclusive leadership can best be used to improve service quality and patient care as the reforms move forward.