I guess most chief executive colleagues are reflecting on what “their NHS” will look like in the future. But it is not just personal futures that need forward planning.

Primary care trusts clusters, commissioning consortia and health and wellbeing boards all need careful nurturing, despite all the human resources processes we will be navigating in managing workforce change.

If primary care trusts are to give consortia real opportunities to finance quality and efficiency improvements, sustaining and improving performance is one vital ball we cannot drop. 

Another vital component in managing the transition is to nurture GP leadership training and so empower consortia to be credible stewards of our NHS.

My PCT’s experience is that we are getting close to leaving a legacy of well managed finances. But not for one minute are we thinking the job is done. Financial good management is a hungry beast and even following a successful turnaround there can be no resting on your laurels with thoughts of “over to you in the consortia”. The consortia need to acquire competencies to keep improving performance.

Here we have our dilemma. Can we be confident the consortia will have the ability to take on the financial burden and accountability? The jury is out. Will the hard won sustainable financial position become unsustainable all of a sudden? Very possibly. Do GPs really want to do this?

Recognising the problem is half the solution. This is where the Royal College of GPs leadership scheme comes in. It jumps off the page as one of the opportunities for GPs to broaden their skill set.

In its promotional material it offers GPs the chance to “develop the skills and behaviours associated with effective commissioning and credible leadership.” It also says it will help GPs lead, persuade and challenge colleagues, work collaboratively and think strategically.

All well and good, but giving the theory without practical support is unlikely to embed new skills and learning.

A support network could go some way to achieving the hands-on support needed and the college has moved ahead with the NHS ConfederationThey are putting together their complementary experience to provide this support.

As RCGP chair Clare Gerada has said, “the white paper offers opportunities and many challenges for health professionals with the new world of commissioning taking us [the medical profession] into previously uncharted waters”.

The Leadership Academy in the North West offers similar opportunities and there are countless materials and support approaches from bodies such as the NHS Alliance and National Association of Primary Care.

There is also the option of following up on any of the new private sector offers now cluttering GPs’ mailboxes.

The rub however, is that for most GPs it means spending money that previously has not been a consideration. Whether it be buying practical support directly or learning how to run a consortium, it inevitably means time spent away from the clinic.

Nearly all GPs will see their own practice as their primary commercial venture. So “back fill” money needs to be there to smooth the change and to help the commissioning business develop alongside the day job.

This opens doubts in many GPs’ minds as to whether the £30 or so per patient running costs will go very far in covering the absence from the practice to sit on committees, learning to manage, and to contract and pay for commissioning support.

So is the real change a cultural one? Swapping sessions to be part time managers will not deliver for patients. That good financial legacy we have worked on could look under threat if the practice interests conflict with the mission of the commissioning consortia.

Some transition toward competent and possibly integrated clinical, health and business management is one solution. But with the financial challenge facing the NHS, I wonder whether the cultural change needed will be too profound, even if management support is realised.