To help CCGs tackle the challenges facing the reformed NHS, distributed leadership needs to replace the historic top-down model, says Helen Brown

The traditional NHS model of top-down, hierarchical leadership is ill suited to the complex challenges facing new leaders in the reformed health service.

Those leading clinical commissioning groups in both clinical and managerial roles increasingly recognise that leadership in today’s NHS is first and foremost about helping others to lead: from GP colleagues and practice managers to patient groups.

‘The distributed leadership model is well suited to a complex and multilayered environment like the modern NHS’

This means building relationships, ensuring people buy in to shared goals and ways of working, being open to challenges and establishing mutual trust.

In essence, the focus must be on building greater capacity to create positive change in the interests of patients and the wider community.

Sharing leadership

As the first wave of CCGs is authorised, the government’s target for transferring the responsibility for local health services in England next spring moves that little bit closer.

But with CCGs still operating in “shadow mode” there are, understandably, a number of clinicians and other board members who remain unsure about how they will manage to lead this massive change programme in an institutional landscape still in flux.

Amid this change and uncertainty there is a growing appreciation that traditional forms of leadership are less conducive to addressing the complex challenges facing the health service and its partners.

Making progress around reducing hospital admissions or achieving public health priorities is only possible with the active participation of local authorities, voluntary and patient groups, and staff at all levels. Unlike in the past, the bodies making commissioning decisions are themselves partnerships and membership organisations.

‘The ability of leaders to establish a clear vision and set of principles is crucial’

In OPM’s work helping CCGs around the country prepare to take on their new powers and responsibilities, we find that governing body members make the most progress when they work hard to build leadership capacity throughout the patch they serve.

This model, commonly known as distributed leadership, is well suited to a complex and multilayered environment like the modern NHS. We believe the most effective local areas will have leaders at all levels, working towards common priorities.

Making a positive shift towards distributed leadership as a central tenet of practice is a complex and continuing process, but from our work so far it feels like there are three key areas where action is needed and when undertaken it will have the most noticeable effects.

Key ingredients

First: balance vision with flexibility. The ability of leaders to establish a clear vision and set of principles, based on the needs of patients, members and the public, is crucial. But this needs to be negotiated and there must be space for colleagues across the system to interpret how best to achieve the overall goals in any given situation.

The CCGs that have managed to establish this kind of framework for action have listened, debated, acknowledged differences, sought consensus and then brokered commitment to clear and specific outcomes, rather than issuing detailed instructions. 

Second: open communication channels. As well as the governing body members, everyone from practice staff and other clinicians to managers and leaders of community groups has an important leadership role to play. They all need to feel they have the legitimacy to act and that their voices are being heard.

Practical steps can include establishing a dedicated information and discussion space online where people involved in delivering healthcare can contribute their ideas and views; putting CCG business on the agenda at meetings where health professionals come together, as well as circulating blog posts, newsletters and examples of good practice.

Third: build collaborative capacity. This is new and challenging territory for everyone. A great deal is being asked of CCGs at a time when money is tighter than ever and the demands on health and social care are increasing. Only by building relationships across organisations and sectors can more be achieved with less.

In practice, this means proportionate investment of time and resources in things such as peer-to-peer mentoring and buddy schemes, individual and team coaching, and building and sustaining multidisciplinary practice networks. These help individual leaders to be more resilient, adaptive and strategic.

Together, these core elements of a distributed leadership model can help the efforts of diverse organisations and people become more than the sum of their parts.

Helen Brown is a principal consultant at OPM