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The wrong kind of leadership


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Friday, 30 September 2011

The wrong kind of leadership

Shock and outrage greeted the news this week that in an official list of top NHS leaders only 4% were GPs.

Here they are bravely preparing to set off in their armoured CCGs to do battle with waste, disease and foundation trusts, and high command has just rewarded them with a smack in the chops. Well, that’s what it says in the HSJ.

A few GPs were rolled out to complain that the story confirmed their worst fears, but all it really confirms is the increasingly desperate obsession with leadership.

The HSJ didn’t discard all the facts that got in the way of the story, it just concealed them near the end. Only 4% of people on the list had GP in their job title, but “a further handful could be GPs”, it conceded. According to the DH, which compiled the list, 35% of the 918 people on the list had a clinical background.

It doesn’t matter much either way. Of course the country isn’t overrun with seasoned GP leaders. How could it be? Until CCGs get going and GPs get to do leadery things they are not going to get into any league tables or win any medals.

Expecting GP leaders to spring fully formed from their surgeries is as silly as describing X Factor hopefuls as stars.

Even so, CCG senior officers will need to be able to “demonstrate leadership” as one of the conditions of authorisation, as if this were as straightforward as demonstrating a vacuum cleaner or the efficacy of a new brand of washing powder.

Leadership development programmes may help, so long as you believe leadership can be taught. Conventional wisdom says it can only be learned.

Producing lists of top leaders is a harmless enough pursuit as long as no one takes it seriously. Unfortunately many do. There has never been a shortage of organisations encouraging doctors to think of themselves as leaders.

Successive governments have also flattered the leadership pretensions of doctors, promoting vanity and political ambition much more successfully than real leadership.

So long as it were only necessary to keep GPs onside to smooth the annual pay deal with the BMA, none of this really mattered. Now that true leadership is required it’s a bit of a problem.

Leadership does nothing on its own. Good management is just as important, but management has become a dirty word equated with inefficiency, incompetence and the caricature old world of PCTs.

As the writer Stephen Covey put it, “Effective leadership is putting first things first. Effective management is discipline, carrying it out.”

Just as the stock value of pathfinders fell sharply as each new wave was announced in quick succession, the designation leader will cease to mean anything if it is too liberally and thoughtlessly applied – and if there are no footsoldiers lining up behind the leaders or prepared to go on ahead.


kburke says:
Sep 30, 2011 11:54 AM
Do GPs want to be 'top leaders' or are they happy doing what they're paid to do - caring for their patients? Surely they are trained to diagnose, sympathise, treat, support ... if they wanted to be leaders and managers wouldn't they have done business degrees and gone to work for big global companies instead?
jpatterson says:
Sep 30, 2011 12:41 PM
It's a good question. The number of networks and clubs with "leadership" in the title suggests that there are plenty of aspiring leaders. But perhaps the appeal of leadership diminishes when it becomes compulsory and accountable.
ravon says:
Oct 01, 2011 07:32 AM
In 40 years of involvement (as a finance and IT person) in healthcare for over 40 years in the UK & Hong Kong and I support the views above. I find it very sad and disappointing that successive govenments just don't have an indepth understanding of what is really needed. Let's have a fresh look and approach and make the NHS the best in the world. At the moment it is probably the best regulated but at what cost and impacY on performance/outcomes, we are below avaerage at least. Many trusts are far too small to be viable economic healthcare units, let's have a business like solution. Leadership is critical and at the moment the proposed reforms can only make things worse. Oh to be involved.