Why I chose... to work as a CCG chair
South London-based GP Dr Helen Tattersfield explains how and why she made the decision to take up, and later retire her role as chairperson in her local commissioning organisation, and questions whether GPs can sustain a joint partner-chair role in the long-term
Name: Helen Tattersfield
Role: GP partner and former CCG chair
I have been a GP since 1990 first in a small partnership and then branching out and setting up my own practice, literally starting with a bare piece of ground and about a 1,000 patients, which now houses a purpose-built surgery for over 4,000 patients.
As a partner at a new and growing practice I got involved in fundholding and the practice joined a local ‘multifund’. After that, I became involved in practice-based commissioning and from 2005 I led my locality, and then the Lewisham Federation, which has smoothly morphed into the Lewisham CCG.
Why I chose this work
I believe that GPs have a huge amount of collective wisdom gained from years of working in the same area and an ingrained desire to make people and communities better. We know our patients, know our environment and most importantly, we know what works and what doesn’t. Who better to be put in charge of commissioning services for our patients than we who know them and their needs best?
I was frustrated by years of sitting on the side lines being asked for advice but generally ignored, and watching poorly-conceived plans produce little (if any) positive outcome for patients or GPs. There was clearly room for improvement locally, and I felt I had the background to make a difference.
I took a great sense of wellbeing in leading such a successful organisation. In our first few months we improved vaccination coverage by 10%, reduced prescribing spend and (by improving community provision) reduced COPD admissions by more than our QOF forecasts said we would. We achieved authorisation in the second wave and have consistently surprised our mentors by our effectiveness and outcomes.
Personally, I found it stimulating to meet leaders in healthcare through my role, and I enjoyed the opportunity for personal assessment and commendation on a level that I feel is currently missing from general practice.
Leadership skills are key to keeping CCG members engaged and supported, as is the ability to juggle the chair’s role with demanding and critical leadership of your own practice. There was also the increasing need for public speaking and media engagement, as plans to reconfigure our local trusts were being forced upon us.
Although not strictly ‘skills’, high energy and morale are also critical to survival and success in a CCG.
Dealing with the imposition of reconfiguration in the local area, with endless ‘advisory’ meetings and final complete overruling of the views of the CCG, was hugely challenging. It tested the role of the CCG in the wider commissioning environment, and tested our and the CCG staff’s endurance in standing up for the needs of our deprived population.
There have been some challenges from members, and rightly so. Keeping the right level of engagement has not always been easy.
But the most significant challenge for me was simply finding the time to do all the requirements of both the GP and chair roles fully. The greatest strength of a GP commissioner also turns out to be its greatest weakness - namely, the fact a commissioner is also a working doctor. The absolute need to maintain an effective and acceptable commitment to my own practice and patients which in turn would provide credibility to the position as chair with both members of the public and GP membership was challenged by the increasing demands of commissioning.
Both jobs being vitally important (and both having the need for immediate dedicated response) does not lead to restful nights and calm days.
Life became an endless round of meetings, surgeries and practice administration, which overran into evenings and weekends, and left little time to think (and no time for relaxation or household duties). This was OK for a while, and unavoidable during all the vital development stages for the CCG, but could not be sustained in the long-term.
Our CCG’s constitution required annual elections and I had commit, or risk pulling out sooner than I would otherwise choose to.
There was an obvious successor to take up my role who was respected by GPs, had all the right experience and, unlike me was from a large practice better able to commit to the CCG without compromising his practice business. I left the CCG in good hands, with effective and dedicated clinical and admin teams who will go from strength to strength.
In the meantime, I can return to the daily privilege of helping my patients through their increasingly stressful lives, ensuring my practice provides the best possible care - and maybe having a bit of personal time).