There are a number of variants on the cartoon about an alien asking someone or something to “take me to your leader.” Of course we all laugh because we can see the alien doesn’t realise they are approaching the wrong person or thing. Now, there is a new version being played out between PCTs and consortia and it is no laughing matter. Who is the leader in a newly formed consortium? What mandate and authority do they have?
In my experience of organisations charged with making decisions about allocating large sums of public money, the buck has to stop somewhere. Someone, or some well defined group, has to have the authority to make a decision. There need to be processes to ensure that decision making is well-informed, open and transparent. However, it may be a decision that some in the organisation don’t particularly like or agree with and, ultimately, someone or some group, has to be able to say ‘this is what we will do’.
We are entering the serious business of making the transition from PCT-led to GP consortia-led commissioning. The operating framework indicated that we need to commit at least £2 per head of population to support the development of consortia. In Lincolnshire, that is over 1.5 million pounds of public money (and even that is probably not enough).
If you have worked in or with general practice then you will know that securing a mandate across multiple practices is not easy. It has often been described as like herding cats. Medics are trained to be highly autonomous, responsible for their own decisions and disdain being told what to do. Yet we are faced with having to make tough decisions and we need to be able to challenge clinical behaviour and have willingness from the profession to support that.
The organisational development agenda for the new GP commissioning consortia is a big task. In order to start it, PCTs need to know who the accepted leader is, who has the authority to speak on behalf of the consortium, so that resources and people can be aligned and assigned to support the transition from where we are now to where we need to be by 2013.
This is the first big hurdle for all emergent consortia. Will practices give a mandate to someone to lead? What checks and balances will they put in place to minimise bureaucracy and allow decisions to be made and complied with? How quickly can they get that leadership in place? The PCT can’t do it, shouldn’t do it. The secretary of state has made it clear he wants this to be a bottom-up process. Whatever process is used needs to be designed and owned by the consortium.
Maybe what we need is a new cartoon, one with an alien (aka PCT) in front of a herd of cats asking, “show me your leader”!
Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.