Kathy Doran's mix of civil service and NHS experience should see her refining 'the art of the possible' in her new job as NHS director of primary care.Alison Moore reports

Few NHS managers can have had such a varied career path as Kathy Doran, the new NHS director of primary care.

Since joining the civil service as a graduate trainee in 1978, she has worked on both sides of the Department of Health/NHS divide, had experience at unit, health authority and regional level, and even been private secretary to junior health ministers. And she has found time to take short breaks to have three children.

If the low point of her career was a job reviewing circulars - when she returned to work after her first child - she could be forgiven for thinking that the best is yet to come, as she takes on her new post at a time of massive change in primary care.

Not surprisingly, Mrs Doran believes all these roles have helped to equip her for the challenge that lies ahead. 'I am coming full circle in a way, ' she says. 'One of the strengths that I can bring to the job is the blend of civil service and NHS experience. The Department of Health can only function by working closely with the NHS, and I hope that I can do that.'

Although her role involves overall policy responsibility for primary care, she is swift to point out the basic shape of policy is very much set by the NHS plan, although how it will work in practice is still quite open.

Her current role as director of primary care and organisational development at Wirral health authority is in many ways a mirror of the issues she will have to face at national level, she says. It has obviously given her a feel for the grassroots concerns of primary care workers and for the intricacies of dealing with independent contractors such as GPs.

'I have seen the effect on them of the various changes and reforms - what has been good for them and what has been more difficult, ' she says. 'I am very conscious of an overload factor.'

Her approach seems to have been appreciated. Wirral local medical committee chair Dr Murray Freeman describes her as 'one of the best directors we have ever had'.

He says she has an exemplary relationship with GPs, is innovative, and believes in co-operation and collaboration. 'She will be a great asset - she has such wide experience at the coalface, ' he adds.

Innovations in her time at the Wirral include introducing a comprehensive out-of-hours service, combining telephone advice, home visiting and an out-of-hours centre - these are commonplace now, of course, but were less so even three or four years ago.

She has also pioneered a sabbatical scheme, allowing GPs three months off, with bursaries to further their studies and a salaried locum to cover their practice responsibilities.

'The GPs that have been on sabbatical have come back refreshed and renewed, ' she says. She will not commit to pushing for such a scheme at national level but points out how well it fits into national agendas such as continuing professional development.

Her appointment has been warmly welcomed by many NHS organisations, especially as there is a perception that primary care policy may have drifted recently and there is a need to re-focus.

Jane Austin, policy manager at the NHS Confederation, says: 'She is very well thought of.

'What we are looking for is strong leadership which she will definitely bring to the job.

'It is an important time for her to make her mark. There are some areas that need looking at, such as primary care trusts as commissioners.'

And David Panter, chief executive of Hillingdon PCT, welcomed the appointment of someone who comes fresh from 'working in the field'.

'This must be about the most exciting time to go into the role, given the modernisation agenda and what it means for general practice and primary care more generally, ' he says.

'In three to five years' time primary care will be unrecognisable.'

Mrs Doran will take up her new job at the beginning of March.

Initially, she plans to remain based in the Wirral - her children are at important stages in schooling - and commute to the NHS Executive headquarters in Leeds.

She expects to spend a couple of days a week in London.

So what personal characteristics does she think will carry her through the rigours of her new job? 'I am a born optimist, but I am fairly pragmatic in my approach, ' she says.

'I hope that I do not get too upset or depressed if people do not like things or we have to change things.

'Health service management is very much the art of the possible.

You have to be prepared to listen to people and take their views on board.'