The role of GPs in leading local health system change

The King’s Fund works with clinical leaders at all stages in their careers and we believe that clinical leadership and engagement needs to be a priority across the NHS. This is the fourth in a series of guest blogs that explores current issues and opportunities for clinical and medical leaders.

Hanging on the wall opposite my desk is a picture of Maya Angelou reading her poem On the pulse of morning at the inauguration of President Clinton in 1993. It speaks of change and of responsibility, and reminds me daily of the role one holds as a ‘medical leader’. Although this term often means different things to different people, for me, as chair of a clinical commissioning group (CCG), it is about social responsibility.

As a GP in Bexley, London, I regularly see a young man who is in the process of transitioning from child to adult mental health services. He has quite severe mental health problems but has slipped through almost every gap in the system. He doesn’t have a family who are able to support him and he didn’t get the opportunity to develop emotional wellbeing and resilience when growing up.

However, we have somehow found each other and he now has somewhere to go when he is feeling vulnerable. We have been able to find a range of community-based organisations that can provide him with the support he needs.

My experience with this young man highlights to me where the gaps are in the system and where we need to focus our energy. Being a medical leader in primary care is about linking together what is happening on a one-to-one level with your patients with what is happening across a whole borough. I am able to understand the local population through my interactions with patients, and influence the system at a borough level to bring about the changes that are needed.

At one point my young patient became homeless and this prompted me to think about our homeless community and the services that we provide for them. I sat down with the leader of the local church groups that are setting up night shelters and as a result of that discussion, some local medical students and trainees are going to volunteer in the shelters. This provides the shelters with essential volunteers, helps our students become more aware of the needs of homeless people and, most importantly, helps provide homeless people in Bexley with a safe place to go at night.

The role of medical leader is equally about working with colleagues and fellow practices to understand, share, represent and act on their experiences and views. My general practice colleagues gain crucial insights about what changes are needed through their interactions with patients and local services. However, general practice is straining at the seams and my role is morphing into one of innovation and creativity – how to support practices to work together, to survive, to be sustainable and most importantly to deliver high-quality care to the local population. Delivering high-quality care means we need to make quality improvement a priority across all parts of the health system in Bexley. We need to work with the services we commission to ensure it is embedded across the board, in our GP practices, community services, urgent care centres and hospitals.

If you’re a GP, one of the key challenges is feeling empowered to take on this type of role. It’s never strictly been on the career trajectory of a GP – you don’t see yourself commissioning local health services. As it isn’t an academic or disease-based role, it can seem daunting to dip a toe in. But I promise, once you do you’ll be hooked. Find a clinical commissioner in your patch and ask them if you can get involved – it’s likely they’d be delighted. It’s a great balancer to the day job and works well with a family too – I do most of the school runs for my two young children and I am grateful for that.

As Tony Benn said, 'the boat-rockers turn out to be the ones willing to build the craft'. We need to find our voices, be honest and be kind. The system needs to invest in training and supporting GPs to become medical leaders, and existing medical leaders play an integral part in making this happen. We need to keep asking how the system is allowing and supporting us to truly embrace place-based leadership so we can create healthier communities – it’s everyone’s responsibility.