In the new world an old challenge will quickly emerge driven by implementation of the reforms. Is it time for the acute hospital to be reinvented? 

The answer is an unequivocal yes because there will be demands to look at healthcare provision in a new way. Why? Because GP commissioners, economic pressures, new market entrants and consumers will, through their actions, make it happen.  

GP commissioners will want new pathways of care spanning organisational boundaries and demand new forms of contract for services to put them in the driving seat of change. New entrant providers will offer ways of treatment more attractive to GPs and their patients, particularly the elderly and those with long-term conditions (often the same of course).  

Responding to this changing context leaders of NHS providers initially will divide into two groups.  First, there are the innovators who have long awaited the challenge of the market, the people who see their organisation as more a holding company for a range of clinical services than an empire of bricks and mortar to be preserved at all cost.  

These are the leaders who will have no difficulty in bringing in new providers to work alongside them as partners or sub-contractors, marketing and delivering their services further afield, and recognising the need for developing new business skills such as M&A and strategy.  Crucially these leaders don’t see their organisation as a series of interconnecting bricks, believing that if you remove one service the whole wall falls down.   

The leaders at the other end of the spectrum will struggle or be slow to respond to the new world. They’ll lack the strategic vision, believing that little will change and the government and new commissioners are not serious about their intentions. These are also the leaders who will wait to be told what they should do - but of course there won’t be anybody there to do that. In short, they will be reacting to the future rather than managing it.   

Above all it will be confidence that divides and differentiates the two categories of leaders. The leaders who lack confidence will be because they haven’t established leadership of their clinical community. The leaders who can lead their clinical community will be the leaders with the confidence to make the most of the new world. It’s this crucial leadership characteristic that will define future success.