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‘Unclear’ which routes offer best leadership experience to new GPs, report suggests


By Sofia Lind
14 June 2022

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It is ‘unclear’ to newly qualified GPs which routes provide the best leadership experience, a major review into NHS leadership has suggested.

Led by Sir Gordon Messenger, the review identified ‘significant variation in leadership structures within and between GP practices, in their networks’.

The report authors were told ‘it is unclear to a newly qualified GP’ how they might gain the best leadership experience, compared to the more ‘traditional clinical director to medical director pathway in hospitals’.

It said: ‘The new place partnership boards and integrated care boards should provide the outlets that are currently lacking for primary care and public health leaders.’

The report also recommended all GPs to receive ‘mid-career’ management training.

It noted ‘an institutional inadequacy in the way that leadership and management is trained, developed and valued’ in the NHS.

Based on interviews with thousands of frontline staff, managers and leaders across health and social care, the report found that the NHS does not sufficiently encourage ‘collaborative behaviours’ and that ‘very public external and internal pressures combine to generate stress in the workplace’.

Within the healthcare sector, there is an ‘institutional instinct’ to prioritise demands ‘from above, including from politicians’ rather than patients, it added.

‘These pressures inevitably have an impact on behaviours in the workplace, and we have encountered too many reports to ignore of poor behavioural cultures and incidences of discrimination, bullying, blame cultures and responsibility avoidance,’ the report warned.

Regarding doctors who are also managers, the report noted that ‘consistency of learning management and behavioural skills is often subsumed by clinical pressures’.

But it said that the proposed management training programme would provide ‘an opportunity for a more structured and collective approach to management training for all clinicians’.

‘For the medical profession, this must include the trained medical workforce (that is, GPs, consultants and doctors in the staff and associate (SAS) grades).’

The report also recommended ‘a new, national entry-level induction for all who join health and social care’.

It said the aim would be ‘to introduce new starters to the culture and values that are expected within services and to foster a sense of belonging wider than the immediate organisation’.

In a foreword, Sir Gordon said that ‘the more that can be done to instil locally a culture of teamwork, understanding and shared objectives across the primary, secondary and social care communities, the better will be the nation’s public health outcomes’.

And he added: ‘To those of our recommendations which require time and resource to implement, I predict a partially understandable reaction that the current pressures on the system preclude investment beyond the urgent.

‘My response is that a well-led, motivated, valued, collaborative, inclusive, resilient workforce is “the” key to better patient and health and care outcomes, and that investment in people must sit alongside other operational and political priorities. To do anything else risks inexorable decline.’

In a statement, the Government said the report recommendations have been accepted ‘in full’.

Health and social care secretary Sajid Javid said: ‘The findings in this report are stark: it shows examples of great leadership but also where we need to urgently improve. We must only accept the highest standards in health and care – culture and leadership can be the difference between life and death.

‘I fully support these recommendations for the biggest shake-up of leadership in decades. We must now urgently take them forward, to ensure we have the kind of leadership patients and staff deserve, right across the country.’

It comes as Pulse survey revealed this week that NHS pressures could prompt half of the GP workforce to retire at or before the age of 60.

A version of this story first appeared on our sister title, Pulse.

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