'Only mugs work in commissioning’: tackling the management brain drain

Despite anti-manager rhetoric spewing from media and politicians, the scheme attracts thousands of applicants, approximately only 1 per cent of whom make the grade.

What do these bright young things want to do with their careers? Anecdotal evidence suggests the majority would like to run hospitals. No surprise there, the appeal of being captain of an NHS flagship has and always will be strong.

However, one commentator made the point rather more starkly to HSJ this week: “Only a mug works in commissioning. Provision means higher pay, less reorganisation, less abuse from politicians and a safer job.”

The continuing relative lack of enthusiasm to work in commissioning should alarm the Department of Health and those leading clinical commissioning groups in particular.

Provision of more care outside hospital walls is required to meet changing patient needs and, in some cases, to deliver efficiencies. Strengthening commissioning is necessary to ensure the NHS plans and purchases healthcare in a way that is fit for purpose and, as far as possible, future proof.

So should we be reassured by the NHS Top Leaders list, which includes around 400 staff who work for primary care trusts and strategic health authorities?

The first thing that should be taken into account when making that judgement is that it is an odd list. Meant to name those likely to have the greatest influence on the NHS’s future, it features, to date, fewer than 50 GPs among its 918 members. An eyebrow must also be raised at any list of “top” leaders which requires Gareth Goodier, chief executive of Cambridge University Hospitals Foundation Trust, to undertake an assessment to achieve a place. His omission, along with others, undermines the list’s credibility. However, the make-up of the list does suggest a reservoir of talent from which CCGs and the NHS Commissioning Board can draw. Unfortunately that reassurance is largely illusory.

One very senior industry watcher describes the brain drain of the most sought after staff from commissioning to the acute sector, especially to foundation trusts, as “horrible”. One particularly hard pressed region has already lost two thirds of its commissioning talent.

The rush to the provider sector is being led by finance staff. Other reports reach HSJ of PCT chief executives and other directors applying for non-board posts at provider organisations. FTs are building from a position of strength, having raided the private sector as well as commissioners to build their “business development” teams over recent years.

Staff are moving partly as a result of the uncertainty rife in the commissioning sector, but there is another reason: pay.

Health secretary Andrew Lansley is talking up CCGs, and by inference the commissioning board, as the main drivers of NHS improvement. However, management cost allowances will restrict CCGs’ ability to pay the going rate for the best staff. The problem will be even more serious for the board, with the ridiculous upper benchmark of the prime minister’s salary likely to have a trickle-down effect of suppressing reward throughout the organisation’s hierarchy.

Across whole swathes of the NHS, commissioning activity is now being driven by deputies and those “acting up”. Unless an effective way is found of retaining talent in commissioning, both CCGs and the board may find the cupboard bare when they attempt to build their teams.

There is one area, however, where talent is being retained on the commissioning side of the fence – the private sector. Many of the businesses looking to provide commissioning support are able to match foundation trusts in pay and opportunities. This trend is highly likely to shape the nature of commissioning support regardless of the preferences and prejudices of CCG leads.