Joe McManners: Primary care development needs to be led by clinical commissioning groups

joe_mcmannersThis season’s hot topic is urgent care, particularly in relation to primary and community based care. Before we get carried away with patchwork top down answers, we need to make sure that changes come from genuine “clinical leadership.” Clinical Commissioning Groups (CCGs) are best placed to make this happen.

To achieve the transformative change that we need to see in the health system, we need genuine clinical leadership. “Clinical leadership” is the buzzword of the day, but what does it actually mean?

It does not mean “clinical engagement,” which is more of an—”agree with us”—change.  It also doesn’t, in my view, simply mean doctors as bosses.  What it does mean is clinicians responding to problems with solutions that come from clinicians.

The problems and agenda may start from public and political identification, but the solutions need to be determined and led by front line clinicians. An example of this is in primary care.

We may not all agree on the problem, and there has been some disgraceful “buck-passing” recently to scapegoat GPs, but there is a growing view that how we operate in primary care needs to develop to manage growing and changing urgent care demand.

I think we have a huge opportunity as GPs to shape this, and develop our services in a positive way to respond. We should be able to demonstrate to others why UK primary care is considered the “jewel in the crown” of the NHS. However we need support and help to do this.

What we shouldn’t do is hope the problem goes away, it won’t. What we also shouldn’t do is wait for a top-down solution that makes little sense, resist it, and then finally implement it with gritted teeth.

In short, what is required is genuine clinical leadership, of a sort that is geared to achieving a purpose. The purpose should be to improve and sustain the NHS. And what we do not need is imposed change. That is not clinical leadership.

Presently, where the clinical leadership in primary care comes from is unclear. The post 2012 reforms have frankly left a bureaucratic muddle in this part of the NHS (and elsewhere). Area teams of NHS England have the responsibility for primary care, but do not have local clinical leaders who can take this on, nor the time, and don’t have the same “roots” in primary care. Local clinical leadership and the planning of the “whole system” rests in CCGs, who can commission pretty much everything, except primary care.  So now there is a situation that prevents primary care being best used to provide solutions to the healthcare systems problems. GPs engaged through CCGs are in the situation of being able to push changes in secondary care, but are holding off helping primary care respond to the 21st century demands.

You don’t need me to join the dots here.

I declare that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare except that of a GP Principal and a CCG clinical commissioner.

Joe McManners is a GP principal in Oxford City. He is locality clinical director for Oxford City Locality, sitting on the board of Oxfordshire Clinical Commissioning Group. He is clinical lead for older people in the CCG and is part of the local Health and Wellbeing Group, leading on areas of integrated care and sub-acute care. For seven years he was an elected member of Oxford City Council, and an executive member for housing for three years. He is also interested in narrowing health inequalities, and wider health and social policy interactions.

He writes in a personal capacity and the views expressed do not necessarily represent those of Oxfordshire CCG.