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How can we develop professionally diverse leadership in primary care?

In our work with primary care networks (PCNs) over the past two years, we have found that most clinical directors in PCNs are GPs, many of whom have taken on PCN leadership roles as extensions of their practice partnership responsibilities, or due to previous roles on clinical commissioning group governing bodies. NHS England’s guidance is clear that clinical director roles in PCNs can be held be GPs, general practice nurses, clinical pharmacists or other clinical professionals working in general practice. So why might it be that primary care leaders aren’t more professionally diverse?

In early 2022, we ran a series of workshops for primary care leaders in north-east England to explore the role of nurse leaders in general practice, primary care networks and beyond. While it is hard to generalise about what will work in a particular place, we noticed several themes that seemed important for organising leadership programmes for all professionals in primary care, not only nurses. Current leaders in primary care, and those involved in training and development for primary care, can use the questions below to think about what might help a wider range of professionals to take on leadership roles.

Career expectations

Professions in primary care can differ a lot in how much structure, progression, choice and expectations around leadership development are built into roles. We heard that these differences sometimes create a sense of a lack of parity between professions, showing up as a reluctance both to step forward for leadership roles, and to accept people who do step forward. People found it easy to talk about the importance of self-confidence, sponsorship, taking measured risks and having awareness of opportunities or interests in explaining why leadership was more multidisciplinary in some places than others. However, we also heard that some issues were difficult to talk about but still important: these included the impact of power differentials between professions, and how confident people felt about their colleagues’ abilities to take on particular roles and responsibilities.

Questions to consider:

  • How can potential career pathways – ie, routes from student to specialist – be made clearer for all professions in primary care?

  • How can leadership development become more of an essential (rather than optional) aspect of career development, eg, as part of continuing professional development (CPD) for all professions?

  • How can current primary care leaders identify and support other team members to lead on service developments or projects, and practise collective leadership?

  • What stretch assignment opportunities could integrated care systems (ICSs), PCNS and new roles offer?

Attracting and supporting leaders

Given the shortages of staff in key professions in primary care, offering more structure could well be a part of attracting the workforce of the future. We heard that regional teams and training hubs could have an important role to play both in attracting primary care staff into leadership roles and creating structures through which emerging leaders could find support, development and encouragement. This would rely on information about development offers filtering through to all professionals in PCNs, which we heard could be a challenge due to the volume of information that primary care organisations already have to deal with.

Questions to consider:

  • How can regions and training hubs co-ordinate and articulate the range of offers available, and provide answers to frequently asked questions (eg, about time commitments, availability of funding, benefits, accreditation, certification)?

  • What formal and informal networks could be created and promoted for peer support, reducing isolation and sharing good practice between practices and PCNs? Would local/regional communities of practice be helpful?

  • How could established local and regional professional leaders offer support as sponsors, mentors and role models?

Addressing practical constraints

Primary care leaders may need to make some tough choices about how to prioritise leadership development at the same time as making sure that the competing priorities of clinical demand and mandatory training are also accommodated. These are issues that aren’t amenable to quick fixes, especially because of the impact of the Covid-19 pandemic and its continuing effects on staff across the whole health and care system – even the offer of backfill or funding assumes there are staff available to take on extra work. However, doing nothing also seems inadequate because making more time for development feels key to creating a sense among primary care professionals of autonomy, belonging and contribution, which are increasingly seen as key to staff engagement, morale, wellbeing and retention. The alternative is to build development into primary care business models as part of a longer-term solution to workforce development, and PCNs and ICSs may offer opportunities to do this that aren’t available at individual practice level.

Questions to consider:

  • How can the time needed for leadership development be recognised and built into practice business models?

  • What opportunities do PCNs or ICSs offer, because of their larger scale, to spread the ‘costs’ (and ‘benefits’) of development?

  • What role could regions and training hubs play in finding and sharing good practice to address these challenges?

Primary care is the backbone of high-quality health care provision, and we understand the pressures many organisations are facing. We’d be really interested to hear about your experience of making progress on the issues described in this blog in the comments below.