Over the last 8 years a wealth of skills, knowledge and experience has built up within a relatively small group of GP leaders who took on Clinical Director roles within Clinical Commissioning Groups (CCGs).  Now that CCGs are coming to an end, what will happen to these Clinical Directors?

The first thing to say is that some CCG Clinical Directors have taken matters into their own hands and have taken on roles as PCN Clinical Directors, thus cementing their place in the new system.  But there are still a considerable number continuing to undertake their CCG roles whose places are less clear moving forward.

The context this sits in is the shift of the system as a whole from a commissioner provider split to one of integrated care systems (ICSs).  Within ICSs the different providers are expected to collaborate and work together to decide how care will be delivered and how resources will be deployed.  One of those providers is general practice.

Many of the functions of CCGs are transferring directly over to the new NHS ICS bodies.  It may well be that roles have or can be identified within these bodies for the GPs in CCG Clinical Director roles.  But the key question is whether general practice as a whole wants these GPs to be deployed providing clinical advice and leadership across the system within the ‘neutral’ NHS ICS bodies, or to be more squarely deployed as part of the leadership team of general practice?

Within CCGs GP Clinical Directors have an explicit remit as GP leaders within GP membership organisations responsible for the health of the whole population.  Within an NHS ICS body, it is less clear that any clinical leadership role should be filled by a GP.  They could just as legitimately be filled by clinicians from anywhere across the provider landscape.

If general practice is to genuinely operate as an equal partner with an equal voice within ICS discussions, it will need leaders who are able to develop strategy, think strategically, and operate politically.  These are exactly the skills that CCG CDs have been developing over the last 8 years, and are not skills that commonly exist amongst the provider-based GP clinical leadership teams.

The Consultant leadership within an acute trust is primarily deployed in medical and clinical director roles within the hospital.  It is only when these roles are filled that it will start to consider supporting system roles.  General practice is in danger of having this the other way round: making sure the system roles are filled before ensuring it has the internal leadership skills and expertise it needs.

History is, inevitably, getting in the way.  GPs who have undertaken CCG Clinical Director roles are sometimes perceived as being distant from core general practice, particularly when they may have been on the commissioner side of developing services and specifications that practices may not have been happy with.

Equally funding is a barrier.  CCG Clinical Directors were well remunerated for their time, and there is no obvious source of remuneration for GP leaders outside of the PCN Clinical Directors at present.

But general practice in every area needs to think through how it is going to be effective in the new world of ICSs.  CCG CDs are a hugely valuable resource for general practice, and the service as a whole would be well advised to consider how it can ensure that this resource is deployed where general practice needs it, rather than passively allowing the system to decide where it should go.