If I were still a CCG CEO
GP leaders should be released from CCG boardrooms back to general practice if a real solution is to be found
Posted: 4 August 2016
Writer: Ben Gowland, director, Ockham Healthcare
A year ago I resigned as accountable officer of a clinical commissioning group (CCG). I was becoming increasingly disillusioned with the ability of CCGs to make real change happen. Instead, I have focused the last year on understanding general practice better and working out what I can do to improve things.
I have already learned a lot. For one I hadn’t been fully aware of the extent of the crisis in general practice. Within the CCG it was hard to distinguish complaints from member practices from signals of real distress. I have also realised that for all the independence GP practices have, they are at a point where what they really need is genuine help.
So how has my perspective changed? If I were still a CCG CEO, what would I be doing now?
For me, the biggest barrier to change in general practice is time. GPs and practice managers lack the headroom to properly assess the landscape within which they are now operating, and to identify the best strategic option for their practice for the future. It’s no longer as simple as doing what the practice down the road is doing: big problems require bold actions, and deciding what to do and when to do it is not easy.
The question I would be considering is how I could find the leadership, the space for that leadership, and the support needed for GP practices to identify and move towards a new future. I have thought hard about this and I think there is a way, a practical action that CCGs and the GP leaders within them can take, that could have genuine impact on the future of local general practice. CCGs could second those GP leaders in the CCG who want to lead the development of general practice back to general practice, on their existing pay, so that they could do exactly that.
Why do they need to be seconded? Well, GP leaders in CCGs are reimbursed for their time. If that stopped, the GPs would have to go back to clinical practice, and would be just as overwhelmed as everyone else working full time in general practice. What, in effect, the CCG would be providing is funded GP leadership time for local practices to use to develop themselves.
Why the GPs in CCGs? Why not just fund some GP time for GPs who wanted to do this? There are three reasons. One is the skills needed for the development of general practice involve persuasion, working with stakeholders, and building alliances across localities – skills GP leaders in CCGs have been developing for the last few years. Secondly, by using the GPs already funded in the CCG the scheme is effectively cost-neutral. All the CCG is doing is prioritising the use of the GP leaders time to do this over the other calls on this time. Finally, really good GP leaders are in relatively short supply, and the majority have found their way into CCGs. There is not an untapped army of GPs waiting in the wings to take this on.
There is a whole set of practical issues that would need to be overcome but none appears to me to be insurmountable. The challenge would be persuading the GP leaders that this is where they are most needed, and the GP practices that this is a genuine offer of support rather than a CCG attempt to force federations (or the like) on its member practices.
Something needs to be done. At the end of the day, only GPs can really develop general practice. And if the best GP leaders are stuck in CCGs, they are not where general practice most needs them right now. Letting go of these GP leaders might be the most powerful action CCGs can take right now.