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How to... Play a major role at your PCT

Could you be PEC chair or PCT medical director? By Professor Ruth Chambers

As an experienced GP, you may wish to take on a more strategic responsibility at your PCT for providing care to patients.

If you want to get involved in shaping the development of local healthcare services and making challenging decisions about finance and resource allocation, health inequalities and risk assessments, there could be a role for you.

Dr Dennis Cox: clinical risk management experience was a stepping stone to becoming a PCT clinical governance lead and later PEC chair (Photograph: Simon Weber)

PCT management
There are three lines of management at PCTs. These are headed up by the chief executive, the PCT chair (representing the lay population) and the professional executive committee (PEC) chair (representing clinicians) who are jointly responsible for all aspects of the PCT's functions.

The medical director or associate medical director comes within the chief executive's line of management.

The PEC chair post is now filled by appointment rather than by election.

PEC chair
The PEC chair provides input on clinical issues and local healthcare decision making.

As a PEC chair you must retain a patient caseload to ensure that major health decisions you help make on behalf of the local population are founded in real life rather than being exclusively management-led.

The role is what you make of it. You are a senior clinician in the organisation, but you have to add value to the role yourself by becoming involved in policy making, taking on clinical responsibilities and proving the value of a strong, independent but corporate clinical voice.

You are there to provide a sensible clinical viewpoint but you will need to learn how to be part of the organisation and not simply represent local clinicians' interests. This may mean arguing within the organisation but presenting a united front outside.

The pay scale for PEC chairs is negotiated locally and you can expect it to be similar to the average income of a GP partner.

Medical director A strong clinical perspective, knowledge and judgment are the sort of qualities PCTs look for in applicants for associate/medical director posts.

In future, the PCT medical directors role will include being the responsible officer who leads on medical revalidation and recommends (or not) local GPs for relicensing.

The salary for a medical director is likely to be on the Very Senior Manager scale at circa £100,000 per year, or pro rata this if the post is less than full time. Associate medical directors may be on the same pay scale.

Birmingham GP Dr Ken Deacon is associate medical director at South Birmingham PCT. He works four sessions a week as clinical lead for clinical governance and quality improvement.

Dr Deacon's background includes urgent care lead for the PCT, and clinical lead for the local ambulance services. He initially took up a role as GP quality lead but progressed to associate medical director soon after.

PCT advertisements for medical directors typically call for inspirational, dynamic leadership and expertise in performance, safety and clinical governance. They expect the medical director to be a strategic thinker with excellent business planning and communication skills, who can work effectively across the PCT and with external stakeholders.

You need to agree a well-defined job description with specific objectives and good administrative support.

CASE STUDY: PEC Chair Dr Dennis Cox

Dr Cox was a GP in St Ives, Cambridgeshire from 1984 to 2007. Initially he applied to be out-of-hours clinical lead for his local PCT. In view of his experience as a clinical risk manager at a medical defence organisation, he was asked to be clinical governance lead instead. Then, when a PEC vacancy came up he took that on as well.

This meant Dr Cox was working three days a week as a GP. He was elected PEC chair within a year but spent six months as deputy chairman (shadowing the PEC chair and learning the role).

When several local PCTs amalgamated, Dr Cox became interested in helping to create the new organisation (for example, interviewing chief executive applicants). He was appointed as PEC chair for the larger Cambridgeshire PCT.

It is a busy role. He is involved with performance matters and is a member of the PCT decision-making group. He sits on the exceptions panel which considers requests to fund treatments not routinely commissioned. He is a member of the executive management team and the PCT board. He chairs the joint prescribing group, and the SHA's PEC chairs group, sitting on three SHA Darzi committees.

He also works closely with practice-based commissioning consortia and groups.

Dr Cox has now moved almost entirely into clinical management. He is fully employed by Cambridgeshire PCT while still doing some clinical GP work in a local practice. He has been appointed the PCT's director of clinical redesign which carries real power and responsibility.

He also has a national role on the DoH national clinical assessment team, undertaking clinical reviews of major services redesign projects.

  • Professor Ruth Chambers is honorary professor at Staffordshire University and a GP in Stoke-on-Trent.

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