primary care groups

The relationship between chairs and chief executives is like a marriage. Rosemary Stewart examines the do's and don'ts of getting hitched happily in PCGs

An effective relationship between the chair and the chief executive will contribute to the success of the new primary care groups. The importance of the interaction was shown in a study in the late 1980s of the role and relationship between the newly appointed district general managers and chairs over a period of two years, part of a wider study of the nature and problems of the district general manager's role.1

Even 10 years later, and in a different kind of NHS organisation, there are relevant lessons for chairs and chief executives of PCGs from the findings of that study. The chairs we interviewed differed widely in how they interpreted their role, playing one or more of five possible roles.

Partner: the chair and the chief executive complemented each other in managing their district.

Executive: the chair instructed the chief executive and other staff to take action.

Mentor: the chair acted as coach and counsellor, positively seeking to influence the chief executive's behaviour.

Consultant: the chair waited to be approached for advice.

Distant: the chair turned up only for board meetings and obligatory external meetings.

Chairs who mainly played the executive or distant role were unpopular with their chief executives. Otherwise what the chief executive wanted from their chair depended on how experienced they were, how difficult the situation in which they worked was, and what the chair had to offer.

All the chairs we interviewed saw themselves as monitoring the chief executive, making suggestions about how they could be more effective.

Guidelines for chairs

The research showed that the relationship is an unusual one because of the mutual dependency: it was most often described as being like a marriage.

The study provided guidelines for a successful relationship between chair and chief executive. The following guidelines for being a good chair, which arose from our research, should also apply to the new chairs of PCGs.

Take time for, and require, sufficient briefing for board meetings and for other important meetings.

Maintain contact with board members and know what they can best contribute.

Give time to act as a sounding board for discussing policies and tactics.

Relate effectively to the major external contacts.

Appraise the chief executive and help them to build on strengths and minimise weaknesses.

Avoid interfering in day-to-day management.

Avoid making statements to the press without consulting the chief executive.

Guidelines for chief executives

The guidelines for district general managers, which arose from our research, should also apply to the chief executives of PCGs.

Consider what the chair wants from the job and seek to provide that, or attractive alternatives.

Try to enhance the chair's credibility.

Make the best use of your time with the chair, particularly if they have little time to give.

Think about how you can use your chair to keep in touch with what is happening in the area.

Recognise the chair's expectations of you. But also consider whether there are some that you think are inappropriate and should try to modify.


Both the chair and the chief executive have leadership roles, but because of their different positions they have a different arena in which to exercise them: the chief executive with the staff and the chair with the board. However, they should also support each other in seeking to lead the many groups on whose co-operation the PCG will depend.2

One unusual problem for chairs and chief executives of PCGs will be that very few are likely to have had any experience of this distinctive relationship. Two probable advantages of the GP chairs come from their professional role. First, they will not be in danger of becoming so absorbed in the chair's job that they lose their capacity for a greater detachment than the chief executive. The second advantage is that they cannot devote too much time to the job and usurp some of the chief executive's role.

The relationship between chair and chief executive can be fruitful or frustrating. Since these are new organisations with inexperienced chairs and chief executives, no research in another setting can be a perfect parallel. Only experience will teach us what distinctive problems are involved, or what distinctive facets of familiar problems.


1 Templeton College. DGMs and Chairmen: a productive relationship? Issue study

No. 1 of the Templeton Series on district general managers, directed by Rosemary Stewart, NHSTA, 1987.

Or see Stewart R. Chairmen and chief executives: an exploration of their relationship. J of Management Studies 1991;

28 (5): 511-528.

2 Stewart R. Leading in the NHS: a practical guide. Second edition. Macmillan, 1995.