career exchange

In our series profiling people in contrasting roles, Jeremy Davies talks to two primary care managers who have taken up new posts created by the NHS reforms

Director of primary and community care, NHS Direct/West Yorkshire Metropolitan Ambulance Service trust

Salary:£48k plus benefits

Mike Vaughan, 53, took up his post after helping establish the Wakefield-based pilot as a management consultant. He developed an interest in management as a first-wave fundholder and became manager of a total purchasing project.

What was your career path?

When I qualified as a doctor I initially planned a career in hospital medicine, but soon decided general practice offered a stability that fitted in with family life. I always valued the one-to-one relationship with patients, and setting up the practice as a small business had its challenges. But once you're a GP principal, that's it in terms of career progression.

When fundholding came along I went part-time as a GP to focus on the management side, and this led to joining the health authority as manager of a total purchasing project. In turn it soon became clear that this should develop into a district-wide project, and that we should make it election-proof, hence the locality commissioning group, Partners in Health, which became a blueprint for primary care groups. My HA contract ran out in July 1997 and I did some management consultancy, and through this became involved in NHS Direct.

Describe your current job

I liaise with all the different elements of primary care, including GPs, dental and pharmaceutical committees, out-of-hours co-operatives, PCGs and social services, trying to develop NHS Direct as an integral part of the NHS. I work with a general director, a director of nursing and the former head of a building society call centre.

We are responsible to the trust chief executive, and have regular meetings with the NHS Direct project team at Quarry House. A lot of my work is about knocking down boundaries and getting people to stop protecting their turf. I also oversee the project's clinical guidelines, which we've tailored to local needs, and am on hand both as a manager and a clinician to help the nurses.

How many hours a week do you work?

I've never counted. It's certainly more than a nine-to-five, but then as a GP I'm used to 24-hour commitment.

What do you see as your biggest challenge for the coming year?

I have a huge agenda of integrating NHS Direct into all aspects of primary care. Eventually this service could become the first port of call for patients, as well as co-ordinating out-of-hours cover and helping PCGs with patient surveys and handling health scares. For this year the main focus is to bring out-of-hours co-ops on board and run things so that we do their triage.

What aspects of your job do you most enjoy?

Pushing away boundaries.

Which parts would you be happy to do without?

Dealing with people who want to protect their own turf.

How do you unwind?

In many ways I don't need to, because I don't get wound up in the first place. I'm a trustee and governor of the Friends of Wakefield Art Galleries and Museums and I'm into wine appreciation, as a member of several tasting groups. It's all about using your senses to the full.

What has been the high point of your career?

Having the opportunity, through my work with Partners in Health and NHS Direct, to get closely involved nationally and regionally with shaping a blueprint for the new NHS.

What's the hardest thing you've had to do at work?

It's tough dealing with GPs who have a narrow vision and feel I've somehow 'betrayed the cause' by becoming a manager. In the past I've also experienced hostility from managers who didn't respect my background.

What would you like to do in the future?

I have a lot to occupy me in this job for the time being. As for the longer term, I tend to find myself one step ahead of the game most of the time, which is partly instinct and partly planning - so once NHS Direct is developed, who knows? My motto is 'use your view of the future to act today to shape tomorrow'.

What other career might you have pursued?

At school I thought about doing pure science, maybe chemistry or biochemistry. I wouldn't mind being prime minister, either.

Could you ever see yourself as a PCG chief executive?

A few years ago it would have been a natural progression for me, but the job didn't exist. I feel I've already been there through my work on Partners in Health. This job feels much freer and more creative, and it will have an impact beyond a single PCG.