GP and PCT boss Dr Paul Zollinger-Read reacts to the plans in the White Paper and the fact that his management job is about to disappear.
A busy week on the ‘dark side': the news is we are to go!
We also hear from the latest Pulse survey that somewhere in the region of 45% of GPs feel their local commissioning group will be able to manage the devolved budget coming their way against 33% who felt they would not - that's a lot of GPs.
Well is it me, or am I detecting that actually most doctors feel that clinically-led commissioning is certainly a very good development? Dare I say it - a step, or perhaps indeed a leap in the right direction?
We may argue about the ability to do it but actually I think it's pretty tricky to say this is not a good idea.
I don't know about you but at med school being taught a couple of weeks of sociology was considered radical. Management skills? No way. Definitely the dark side and not on the agenda.
So how do we now tool up to deliver this? There are a couple of different and tricky challenges as I see it.
The first is to equip consortia with commissioning skills. We know these; they have been well detailed and they are important, but do we need all GPs to recite these mantras before bed each night? I think not.
We need to get a real sense of where GPs add value and where skilled managers come into their own. This is an important issue, but not as crucial as that of leadership and organisational health.
I was speaking to someone recently who works for a bank and he was telling me that it was not unusual for 50% of start up companies to fold fairly quickly; and that's what our clusters are. Over 70% of the failures are due to what we would call poor organisational health.
Over the years I have come to realise just how crucial the internal health of an orgnanisation is and we ignore this at our peril.
It's about how the leaders set the direction, clear accountability of staff, motivation in the organisation, internal coordination and control, well developed leadership skills, supportive culture, innovation and the ability to learn. This stuff has been well tried and tested in industry and is (dare I say it) evidenced based.
We have a once in a generation opportunity to really make clinical commissioning work. Get this wrong and it will be consigned to the dustbin of policy for years, and we will have failed our patients.
Hoping that new organisations will rise to this enormous challenge is optimism in the extreme. Starting from a point where we acknowledge that the health of the new organisations is perhaps our biggest challenge and really investing to get this right will deliver but let's have real focus on this.
Commissioning skills are simple compared to the huge importance and complexity of your organisation's health.
Dr Paul Zollinger-Read is a GP and chief executive of NHS CambridgeshireDr Paul Zollinger-Read