I recently tried to persuade a GP leader (Dr S) to leave his CCG and spend his time helping core General Practice instead. Here is how the conversation went:

Me: The time has come for you, and GPs like you in leadership roles in CCGs, to step down from your CCG role and instead use the skills you’ve developed over the last 6 years to lead General Practice out of its current crisis.

Dr S: I can’t begin to tell you how bad an idea I think that is! First off, I don’t think it is my job to change General Practice.

Me: So whose job do you think it is? Seriously, if it is not your job, whose job is it? NHS England do not think it is their job, and you certainly cannot believe it is the Government’s! Only GPs really understand General Practice. You are now a trained system leader. General Practice needs you.

Dr S: But I‘m needed where I am. CCGs have to be clinically led, and need GPs like me to stay in place. Otherwise they will become just like PCTs.

Me: You yourself are always telling me how serious the crisis in General Practice is. If it really is in such a bad way, why are you not switching your efforts? What is more important, the badge of clinical leadership for CCGs, or the future of General Practice?

Dr S: I have invested a lot in the CCG. I want it to succeed. I don’t want to let down all those I work with in the CCG. I would feel like I am abandoning them.

Me: I understand how you feel, but at the same time you are letting down your GP colleagues, current and future, by not focusing your efforts on General Practice. It is the system’s job to look after the CCG – it is, after all, a statutory body. It is no-one’s job to look after General Practice.

Dr S: But I can do more benefit for General Practice here in the CCG. I control the money here and I can make real change happen.

Me: First, the CCG bureaucracy around conflicts of interest means the change you can effect in General Practice from within the CCG is extremely limited. Second, contractual change is not the answer General Practice needs. It needs to change from the inside, with leaders like you working across practices, winning hearts and minds, finding a way forward.

Dr S: Even if I wanted to leave I couldn’t because my practice needs the CCG money. I won’t get anything for working with General Practice. If I left the CCG I would just have to go back to full time clinical work.

Me: You are right that the incentives in the system encourage GP leaders to remain in CCGs rather than support General Practice to change. At Ockham Healthcare we make the case that the money you earn in the CCG should be transferred with you if you want to make this move, so that you are paid the same for carrying out work to support the development of local General Practice as you are in the CCG. (You can read the report here)

Dr S: But we are talking about over £70K per year. How would this work in practice?

Me: Your CCG could choose to fund you, or indeed any of the GP leaders in your CCG, to work in General Practice by seconding you on full pay on the basis of the benefit this would bring to the system as a whole. You don’t need anyone else other than the CCG itself to agree it.

Dr S: But in the CCG I have a clearly defined leadership role, and everyone understands what it is. What would my role be if I If I left the CCG? Would there even be a role?

Me: There won’t be a marked out role, but there is a huge leadership challenge. You will have to establish your role and gain acceptance from your peers for it. No-one said this would be easy!

Dr S: The problem is I have burnt bridges with many of my colleagues as a result of my CCG role. I am not sure my GP colleagues want my help!

Me: First and foremost you are a GP. You understand General Practice. The fact you have made tough decisions in the past and stood by them in the face of peer resistance shows you are a leader of courage and integrity. You are exactly what General Practice needs. General Practice has to make some difficult decisions about how it is going to change and adapt going forward. Some are not going to like it and the challenge is going to be taking everyone with you.

Dr S: That is very generous, but I am not sure however hard I try that I will be able to persuade my GP colleagues to change.

Me: If you don’t believe that General Practice can get out of the situation it is currently in, do not expect anyone else to. Everyone can change with the right leadership, resources and support. If anyone is capable of helping your colleagues to change, it is you.

Dr S: But where would I go? What would I do? I am not sure I would even know where to start.

Me: You could do worse than following the advice of John Kotter. You would start by listening to your colleagues and really understanding their problems. You would share the experiences and ensure everyone understood the urgency of the situation and the need for change. You would create a change team around you. You would build a vision for the future. You would make sure everyone bought into it, and you would communicate it over and over and over again. You would move to action, creating quick wins to develop momentum. You would build on early successes and make bigger and bigger changes. Eventually you would embed these changes in the way that General Practice operates, completing the transformation.

Dr S: Maybe the idea is not as ridiculous as I first thought! I am not sure what to do

Me: Either General Practice is in trouble or it isn’t. If it is, it needs your help. Don’t leave it to others. Don’t take the easy route of staying put. Take up the challenge. Make the move. Use the skills that you have developed in the CCG to give General Practice a chance. Don’t do it for yourself, do it for your colleagues, do it because you believe in General Practice and the role it plays in the system and the difference it makes to patients. Do it because it is the right thing to do.

Should GP Leaders be leaving CCGs and supporting core General Practice? Let me know what you think: email ben@ockham.healthcare or via twitter @BenXGowland