Doctors managing in primary care

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Doctors managing in primary care

• Naomi Chambers
• Professor of Health Management
• Manchester Business School
• 16 September 2008
• Naomi.chambers_at_mbs.ac.uk

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Summary

• Why this topic ?
• Wider impact of 21 century health reforms
• Emergence of new organisational forms
• Changing job of doctors in primary health care
• Changing relationships
• What does this mean for personal qualities and
  management skills required of GPs?
• Some conclusions

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Why this topic?

• Role of doctors as leaders and as led in public
  sector
• Significance of obtaining engaged followership
  with this group
• Importance of understanding how this group is
  affected by reform as leaders and as deliverers

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Six impacts of 21 century reforms on primary care
from Modernising Government OECD, 2005

• Open governmenteg Freedom Of Information
• Enhancing public sector performance.eg
  outcome-based contracts
• Modernising accountability and control.eg growth
  of regulation risk management
• Reallocation and restructuringeg
  commissioning/provision
• The use of market-style mechanisms to provide
  government servicesoutsourcing, contestability
• Organising and motivating public
  servants.performance management, revalidation
  reward systems

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New organisational forms in primary health care

• 1. Single handed practice/solo family medical
  practitioner
• 2. Group medical practice/partnership
• 3. Nurse-led practice
• 4. Government health centre with salaried family
  doctors
• 5. Commercial provider with salaried doctors
• 6. Urgent care centre

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Change and stability Six roles of GPs

• First point of contact care
• Continuous person and family focussed care
• Care for all common health needs
• Referral and coordination of specialist care
• Pro-active management of chronic disease
• Care of the health of the population as well as
  the individual
• From Chambers and Colin-Thome (2008 forthcoming)
  Doctors Managing in Primary Care An
  International Focus Journal of Management and
  Marketing in Healthcare Vol2 No1

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Change and Stability in Professional Relationships

• Patients/families/carers
• Community services
• Hospitals
• Health service funders

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Tripartite schema(from Darzi, DH 2008)

• Doctor as practitioner (expert care for
  individuals)
• Doctor as partner (stewardship of resources)
• Doctor as leader (changing the system where it
  benefits patients)

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Ergo.. desirable personal qualities of GPs

• Enjoy teamworking and relationship building
• Preference for working in networks rather than
  hierarchies
• Clinical and managerial entrepreneurial spirit
• Tolerant of ambiguity and uncertainty
• Inherently optimistic
• Personally resilient
• Ability to see both the 'big picture' and to be
  concerned with detail

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Ergo.desirable management skills of GPs

• Finance management
• Staff management
• Infrastructure management ( eg IT and estates)
• Business planning
• Performance monitoring
• Influencing and negotiating skills
• Resource investigation
• Public health knowledge
• Understanding how health services in their
  country are organised
• Insight into the health policy development process

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Relevance of leadership theories

• Charismatic
• Transactional
• Transformational
• Situational
• Performative
• Collaborative
• Orchestrative

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Some conclusions

• Personal preferences/orientations becoming more
  important
• Clinical/professional leadership means
  recognising the beliefs of peers
• Job becoming harder not easier ( 3 levels
  individual, team and system)
• Calls for collaborative and orchestrative
  leadership in addition to traditional skills