GPs will have to acquire new complex skills and concepts to be equipped to take over commissioning, says Lubna Haq

The government’s plans to hand commissioning of care over to consortia of GPs or other clinicians mean those running the groups will have to learn new skills beyond their existing clinical expertise and practice management experience.

They will also have to lead, inspire and communicate effectively - to ensure priorities are agreed and objectives are met

GPs who at present work with the local primary care trust will have a good head start in understanding the issues but they will also face new and unfamiliar challenges when they take a lead role in one of the consortia.

How the system will work is not yet clearly defined: no one really knows what the new landscape of health service commissioning will eventually look like.

Potential freedom

This gives local GP consortia plenty of potential freedom to decide how they want to structure and run their operations.

However, if GPs see leading commissioning as purely a transactional process concerned with how to spend money - a skill they can buy in - they are missing the point.

The focus should not be on the technical and process side but instead on strategic leadership and forging a joined up approach across health and social care.

So what competencies, behaviours and leadership skills will clinicians need to develop and how should they set about getting them?

Fostering debate

First, GPs are going to have to think and look beyond the individual patients they see and the practices they manage.

They will need to consider the health and wellbeing of the whole local community.

This will mean fostering debate and discussion and giving patients an opportunity to voice their views and concerns - engaging with the community.

GPs who already have close links with the PCT will already be thinking more broadly about some of these issues.

All those running GP consortia will need to take a public health view of the whole population, which may be contrary to the needs of an individual patient.

This will be true not just in obvious public health areas such as tackling obesity and smoking, but in the minutiae of procedures across all areas of healthcare.


The biggest challenge of commissioning will be decommissioning.

The demands of efficiency savings mean there will be no extra money for new drugs and treatments.

Decommissioning of services is unavoidable and may be the only genuine way to change healthcare without just tinkering at the margins.

Commissioning new services in times of plenty is a completely different skill to freeing up resources from long standing and sometimes much loved local services.

Being unpopular and having extremely difficult local debates with the public, colleagues and providers goes with the territory and will be a steep learning curve for the new consortia leaders.

Complex relationships

Directors of consortia will be working in partnership and collaboration with a very broad group of individuals and organisations, ranging from other clinicians, directors of public health and local provider organisations to councillors, community leaders, social enterprises and the voluntary sector.

They will have to engage with the gamut of health and social care needs across their local population.

Influence and delivery

The government’s plans focus strongly on devolving power to a local level, so clinicians will have to beef up their performance management skills to ensure their commissioning actions are having the desired impact across all the organisations they work with.

They will need expertise in negotiating, influencing and delivering results through other people.

They will also have to lead, inspire and communicate effectively - to ensure priorities are agreed and objectives are met.

Accepting ambiguity

There is a level of ambiguity and “no right answers” that go with effective commissioning - especially in times of contraction rather than growth.

With many having criticised PCTs for their lack of success, GPs are going to have to learn to be comfortable with taking on this ambiguity and making commissioning decisions, affecting their whole population, in shades of grey.

Ultimately as commissioners GPs should have much more control over ensuring their patients get the best care available.

But to do so they will have to shift their mind set from the individual in the consulting room to the board room.

Popularity does not go with the job.

Opportunity or threat?

GPs of the future will find that rather than commissioning healthcare, their challenge is to commission health. They will have to learn about complex collaborative and partnership working that seeks long term strategic gain for the whole population based on many factors.

Those that are already running their own practices will have developed good business skills that will stand them in good stead.

The NHS white paper says the new structure is intended to “empower and liberate clinicians to innovate”. Commissioning and decommissioning ultimately means taking charge of rationing decisions in the NHS. While this potentially puts doctors in the firing line for attacks from heartbroken relatives and a hostile media, it also gives driven, energetic GPs the chance to engage in entrepreneurial thinking and to explore innovative ways to manage healthcare.

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