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Why are GP leaders so thin on the ground?

In recent weeks, I've been struck by two reports in Pulse: the fact that the GPC no longer has any female or sessional GP negotiators on it, and the lack of GPs on CCG boards. The two stories are different, but share the same theme: poor representation of GPs is a cause for concern for the profession's future.

Like most GPs, I went into my profession to make people better – not to be a manager or a politician. But at a time when GPs are meant to be in the driving seat of healthcare, it is ironic that GPs – especially women – are conspicuous by our absence on CCG boards.

Are GPs uninterested in commissioning? Can women not rise to the challenge? I think not. It's that we are too busy doing the day job, alongside what we do as homemakers and parents.

Reflecting on the extra responsibilities given to us by the health act, I wonder if the fundamental things such as the remuneration offered, the time commitment needed or simply not wanting to let our patients down could be holding us back.

GPs are being expected to take on new roles and play an active part on CCGs, yet still carry out the most important job of caring for our patients – without sufficient extra support or resources.

A recent report on representation in leadership roles looked at why more women are not putting themselves forward for bodies such as CCGs.1 Senior female clinicians talk about coming up against two sets of barriers to leadership progression: role conflict and ‘structural' barriers; and individual and organisational ‘mindsets'.

The lack of GPs on CCG boards seems to result from the first set of obstacles – role conflict and structural barriers. GPs operate in 10-minute time frames, and so for us lengthy CCG meetings mean valuable time away from our consultations.

Things need to change so we're not forced into an either/or situation of having to choose whether to be a GP or a leader, when we're perfectly able to be both things. We know from the enthusiasm generated by our own RCGP Centre for Commissioning and the recent RCGP project around sessional GPs and commissioning that GPs want to get involved. GPs are key to making this new NHS work, and it is imperative we have a major role.

We also need to look at the ‘mindsets' that stop women being accepted into leadership. We want to be good role models for those we work alongside and for future generations of GPs. It may be that this is a bigger problem for women than for men – while a practical problem like remuneration holds everyone back, a problem like poor representation targets specific groups – such as female

Our practice population is also very different and more diverse than it was even 10 years ago. General practice is changing and we need to change with it if we are to properly represent our patients.

Overall, we need more investment in our leadership skills and more practical support in our practices if we are to lead from the front rather than be bystanders. But for women, the investment must be not just practical, but professional. If there are no female figures in the profession, who can you look up to? Perhaps it is time for you to ‘be the change you want to see'.

Dr Clare Gerada is the chair of the RCGP and a GP in south London


1 NHS Midlands and East. Releasing potential: women doctors and clinical leadership. 2012.