Evidence submitted by the NHS Alliance
(WP 97)
1. The terms manager and management in primary
care have been historically ill defined but are not interchangeable.
Much of management and leadership in primary care is not undertaken
by exclusively by mangers but also by clinicians and others at
both practice and PCT levels.
2. The managerial task in primary care in
the "new NHS" is particularly demanding and different
from the institutional management focus of, for example a hospital,
because:
(a) At the highest level it is about health
improvement and not simply health care. This requires notions
of working with communities and across agencies. These are not
necessarily conventional management skills within the NHS.
(b) It involves managing with groups and
individuals who are independent contractors not employees.
(c) These groups and individuals are scattered
across large geographic areas, may rarely meet PCT senior managers
and largely direct their own day to day activities. This presents
particular communication and other issues that are quite different
from those faced by managers and management elsewhere.
(d) Critically, it involves the commissioning
and not simply the provision of services, including decisions
as to planning, priority setting service configuration at all
levels and across different statutory and, increasingly, commercial
bodies.
3. Against this background, the NHS Alliance
would argue that both the quality and quantity of management in
primary care has been insufficient to meet past needs and is insufficient
to meet future needs.
4. Key tasks for the future which have been
given insufficient attention in the past include:
(a) The identification of need and demand,
which will require PCTs and PBC consortia to take a more sophisticated
approach to research and data analysis in the future.
(b) Market shaping, which will require PCTs
to balance the need to provide choice with market management to
ensure that services are provided in a sustainable way.
(c) Holding the market to account, which
requires PCTs to act as local stewards of NHS funding and ensure
they achieve quality and value for money from providers.
(d) Holding PBC commissioners to account,
which is crucial to ensuring that all stakeholders—not least
the general public—can be satisfied that the NHS is delivering
value for money, and acting in the interests of patients and citizens
as NHS Shareholders.
5. The Alliance view is, therefore, that
expressions of opinion as to the sufficiency of numbers of managers
alone are unhelpful and potentially misleading. The focus should
be on the overall task, the competencies needed to undertake that
task, and the allocation of those competencies to individuals,
based on ability to achieve end results rather than professional
background. The Alliance would contend however that the objectives
of the NHS will only be met by clinicians, managers and local
people working together.
6. It follows that workforce planning should
be based on an audit of existing skills and competencies; the
identification of future needs based on objectives, and action
to fill the gaps between the two. Given the distributed managerial
responsibility and the more subtle accountability arrangements
in primacy care, this needs to be based on a multi disciplinary
approach reflective of mutual dependency and not a line management
approach. Such a focus is not present within the current workforce
planning as far as primary care management is concerned.
Michael Sobanja
Chief Executive, NHS Alliance
18 January 2007
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