Will this change to the system diminish the goodwill and trust that many patients put in their GPs? And what is the knowledge and skills gap between what GPs are currently focused on and the new expectations being thrust upon them?
It is clear that the challenge for GP leaders is a large one. One substantial – and fundamental – skill they will need is commissioning care. This requires a set of completely new skills for GPs. As a senior GP confided to one of my colleagues: 'we don't know yet what we don't know'. GPs will need support to assess the needs of their patient populations and to put processes in place to ensure that those needs are met.
GPs will also have to figure out exactly what it means to commission care for whole populations taking health inequalities into account (what does it look like when done well?) and how to work with other colleagues such as existing Directors of Public Health and others to gain this knowledge.
One GP has candidly told me: 'Managing budgets on a large scale is not my thing. It is not what I trained to do'. He went further and said that within his practice 'pressure is being brought to bear on colleagues in the PCT. The last thing we want is to inherit overspending from the PCTs; who is looking at how quickly they (PCTS) can become lean, so that we have a chance of delivering to this agenda?.'
This anxiety underlines the need for another skill GPs will need: building relationships with colleagues from local authorities, acute trusts and other GPs; they will need to learn to negotiate with professionals from the public and private sector and they may need to give up some of the autonomy they have come to enjoy as GPs.
Meanwhile, some GPs are flagging up other skills gaps such as the ability to analyse data about the needs of their patient population to enable quality decision-making about the type of care they should commission.
Others talk about the challenge of 'working across boundaries' (modern parlance for ditching autonomy and embracing colleagues from multi-professional disciplines, including community and social care settings, to deliver health care), building collaborative leadership behaviours, managing and disciplining underperforming colleagues, managing change, etc.
And if these were not enough there is also the challenge of a potential conflict of interest in being both providers and commissioners of health care, and having the ability to differentiate skill sets for each of these two core activities. Such a wide range of responsibilities mean big change.
At The King's Fund, we're doing a lot of thinking – across our leadership development, health care improvement, and policy departments – about how best to help GP leaders, and others in the system, to implement this extensive reform. We are inviting discussion, listening to what you are telling us, and co-designing interventions that we hope will ease the transition.
As part of this, on Tuesday September 7, more than 230 NHS leaders – from GPs to existing PCT leads and other stakeholders – came to the Fund to hear from Parliamentary Under Secretary for State Lord Howe and discuss the challenges of becoming the best at commissioning. We've put highlights of the discussions on GP commissioning on our website. Let us know what you think the main skills gaps are – and how we can best fill them.