Doctors managing in primary care Naomi Chambers Professor of Health Management Manchester Business School 16 September 2008

Summary Why this topic ? Wider impact of 21 century health reforms Emergence of new organisational forms Changing job of doctors in primary health care Changing relationships What does this mean for personal qualities and management skills required of GPs? Some conclusions

Why this topic? Role of doctors as leaders and as led in public sector Significance of obtaining engaged followership with this group Importance of understanding how this group is affected by reform as leaders and as deliverers

Six impacts of 21 century reforms on primary care [ from Modernising Government: OECD, 2005] Open government…eg Freedom Of Information Enhancing public sector performance….eg outcome- based contracts Modernising accountability and control….eg growth of regulation & risk management Reallocation and restructuring…eg commissioning/provision The use of market-style mechanisms to provide government services…outsourcing, contestability Organising and motivating public servants….performance management, revalidation & reward systems

New organisational forms in primary health care 1. Single handed practice/solo family medical practitioner 2. Group medical practice/partnership 3. Nurse-led practice 4. Government health centre with salaried family doctors 5. Commercial provider with salaried doctors 6. Urgent care centre

Change and stability : Six roles of GPs First point of contact care Continuous person and family focussed care Care for all common health needs Referral and coordination of specialist care Pro-active management of chronic disease Care of the health of the population as well as the individual From: Chambers and Colin-Thome (2008 forthcoming) Doctors Managing in Primary Care: An International Focus Journal of Management and Marketing in Healthcare Vol2 No1

Change and Stability in Professional Relationships Patients/families/carers Community services Hospitals Health service funders

Tripartite schema (from Darzi, DH 2008) Doctor as practitioner (expert care for individuals) Doctor as partner (stewardship of resources) Doctor as leader (changing the system where it benefits patients)

Ergo….. desirable personal qualities of GPs Enjoy teamworking and relationship building Preference for working in networks rather than hierarchies Clinical and managerial entrepreneurial spirit Tolerant of ambiguity and uncertainty Inherently optimistic Personally resilient Ability to see both the 'big picture' and to be concerned with detail

Ergo…. desirable management skills of GPs Finance management Staff management Infrastructure management ( eg IT and estates) Business planning Performance monitoring Influencing and negotiating skills Resource investigation Public health knowledge Understanding how health services in their country are organised Insight into the health policy development process

Relevance of leadership theories Charismatic Transactional Transformational Situational Performative Collaborative Orchestrative

Some conclusions Personal preferences/orientations becoming more important Clinical/professional leadership means recognising the beliefs of peers Job becoming harder not easier ( 3 levels: individual, team and system) Calls for collaborative and orchestrative leadership in addition to traditional skills