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Primary care “forgotten or sidelined” in new leadership council

21 April 2009

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Primary care is seriously under-represented in the new NHS National Leadership Council (NLC), according to the NHS Alliance, the independent primary care organisation.

Alliance representatives said they found it “disappointing and surprising” to see a lack of primary care input to the recently announced line-up of leaders brought together to champion leadership in the NHS.

A press statement from the Alliance reads: “Policy rhetoric calls repeatedly for ‘a primary care-led NHS’. Primary care is being set the huge task of making NHS commissioning ‘world-class’. Yet once again, it looks as if primary care is being forgotten or sidelined. Surely this cannot be the intention?”

The Alliance points out that while there are 152 PCTs in England and around 23,000 GPs, the NLC has just two “core members” from primary care: one PCT chief executive and one associate director, while its “fellows” include one PCT chair and RCGP chair Professor Steve Field.

By contrast, the NHS’s 117 foundation trusts provide eight members of the NLC: seven chief executives and one chair. The 10 intermediate strategic health authorities provide another three chief executives and one chair.

The NHS Alliance says that leadership is needed at all levels of the NHS hierarchy, and that the NLC’s membership risks retraining the “top tier” in leadership with the same approach, while ignoring team leaders and succession planning through the workforce.

It added that the managerial team in primary care are at the “sharp end of managing the ‘risk sink’ of the NHS”, and their role in commissioning and provision, as well as in ensuring and supporting patient choice, makes hugely important economic decisions.
Ken Aswani, lead of NHS Alliance PEC chairs’ network, said: “90% of NHS care is provided in and by primary care, and policy aims to increase the amount done outside hospitals. As such, we would expect a higher representation – but see more the opposite: less than 10% come from primary care.

“For this to be successful and credible, it needs substantially more primary care representation,” he added.

“It’s not just GPs who lead in primary care,” said Claire Old, lead of NHS Alliance’s commissioning and service improvement network. “Practice-based commissioning aims to be truly multidisciplinary, yet nursing and allied health professional representation from primary care on the NLC – either frontline clinicians or management leaders – is nonexistent.”

NHS Alliance PBC lead Dr David Jenner (pictured) said, “The composition of the NLC appears biased towards secondary care. To have no primary care clinician core member, and just one as a fellow, suggests there is little central perception of the value of primary care and all its professions.”

NHS Alliance

Related story: Membership of new National Leadership Council announced

Your comments (terms and conditions apply):

“I agree there should be more representation from primary care. As usual, primary care is being totally overlooked. It is primary care that is continually doing the work of secondary care as they have failed in patient care, but it always seems to be secondary care that is given precedence” – Janice Betts, Essex