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Commissioning: Ten tips for GP leaders

Professor David Haslam has some timely advice for GPs who take on lead roles for commissioning care.

Professor Haslam: taking a lead role in the wake of the White Paper can be daunting, but GPs already have the skills to succeed (Photograph: Simon Barber)
Professor Haslam: taking a lead role in the wake of the White Paper can be daunting, but GPs already have the skills to succeed (Photograph: Simon Barber)

It is not easy being a GP. For years we have dealt with most of the problems of most of the population for most of the time, but now we have been asked to run the whole English NHS too.

Whatever you think of the White Paper, the implications for many of us are massive.

More family doctors will inevitably find themselves in unexpected leadership positions, for example, in a GP consortium. You may repeatedly find yourself wondering: 'How on earth did I end up doing this?'

You can feel threatened, or stimulated and challenged. But you probably have more skills than you realised. Over the past few years, I have found myself chairing or leading more organisations than I could have ever imagined.

I have made mistakes along the way, and in case you can learn from someone else's mistakes, I want to share my 10 simple tips with you.


1. Remember you have great skills
Every day, in every surgery, you are expected to respond to anything and everything that comes through your door. You have no briefing papers, no script. You have an audience who - most of the time - is attentive and interested. What greater skill could you need?

Even if you end up facing huge audiences, or taking on the media, just remember: they are all individuals, and you spend every working day talking unscripted to individuals.

2. Be organised
For meetings, there are three simple rules. Start on time. Finish on time. Ensure that everyone has the right papers.

These things matter, not just because they promote efficiency, but because your committee or board members will feel they are in safe hands, and that you are in control.

Also, if you are chairing a discussion, be absolutely clear about what decision needs to be made. Otherwise, the discussion will drift into waffle that begets more waffle.

3. Turn accidents into opportunities
This is probably the secret to a fascinating career. If an opportunity comes your way and it is of the tiniest interest to you, grab it.

If I am ever asked to consider a role, I always apply the 'deathbed test'. To do this, imagine looking back on your life. If a career opportunity comes your way, ask yourself if you would rather have tried for it, and not been a successful applicant, or spent the rest of your life regretting not trying.

'If only ...' are two of the saddest words in the English language. If you are not interested, do not apply. You will not regret that either.

4. Be realistic
Do not waste your time or energy trying to change things over which you have no control. Focus on what you - that is you personally - can achieve.

And when tasks look impossible, work out how to break them down into bite-size chunks.

5. Keep your sense of humour
I believe that a key rule of life is 'you don't have to be solemn to be serious'.

Not taking yourself too seriously does not mean that what you do does not matter. It means that you have sorted out your priorities.

6. Surround yourself with good people
Then let them get on with it. Constantly interfering and micromanaging will irritate and disempower your team. Your job is to set the direction, not direct the delivery.

Supporting your team is absolutely vital, so never underestimate the importance of real team-building (and that does not mean paintballing on a dreary industrial estate on a Thursday afternoon).

7. Consulting skills work outside the surgery
Some years ago, when I first dealt with politicians, I realised that the key to a successful meeting was the same as to a successful consultation.

If you do not understand the ideas, concerns and expectations of the person you are meeting with, then the meeting will always end unsuccessfully - just as it always will in the consulting room.

8. Keep disagreements in perspective
Disagreement is probably inevitable. After all, if everyone agreed on everything, we would have worked out long ago how to run the NHS. We do not and we have not.

When people argue vociferously against you, listen but do not take it personally.

9. Stick to your organisation's agreed values
After the Medical Training Application Service crisis in 2007 that impacted on many junior doctors' lives, I was asked to co-chair the Modernising Medical Careers programme board to help resolve the problem.

The board consisted of representatives of the Academy of Medical Royal Colleges, the DoH, the CMO, junior doctors, NHS Employers, the BMA, and so on. I was so far out of my comfort zone I might as well have been at the dentist.

But on day one, I asked if everyone agreed with the core values of patient safety, flexibility, and caring for the junior doctors in the system. They did. This may sound cheesy, but it was critical.

Every time we seemed to be getting stuck, I took us back to these core values. Almost always, the answer to a dilemma would become clear - and tribal attitudes would dissipate. I've used this technique many times - it almost always works.

10. Being a leader can be lonely
Have someone that you can share your problems with. If necessary, contact someone in a similar role elsewhere and meet up occasionally. You are both probably struggling with the same problems, and knowing you are not alone is the reason that self help groups are so often successful.

Pretending that what you are doing is not stressful is a recipe for it becoming exceedingly stressful. So be honest.

And if I had an 11th rule, it would be 'have fun'.


  • Professor Haslam is past president and past chairman of the RCGP and is national clinical adviser to the Care Quality Commission.

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