Clinical Leadership Maximising Potential Talent Management ... Leadership Talent... · Clinical Leadership – Maximising Potential Talent Management & Succession Planning Strategy

“Clinical Leadership - Maximising Potential” – January 2015

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Clinical Leadership – Maximising Potential Talent Management & Succession Planning Strategy 2015 – 2020

1 Introduction

The CCG recognises the importance of growing talent and bringing on board clinical colleagues who have the potential to develop and become leaders in the future. This has been a focus on the CCG since it was first formed in 2011 and remains a priority. This paper summarises the latest research and findings nationally, and that of the CCG locally, and sets out the key areas of focus as the CCG moves forward in its efforts to attract and retain clinical leadership talent.

2 Background

In 2009/10 an Action learning set comprising of GPs interested in commissioning development was formed and met over a period of six months using facilitated sessions to explore how commissioning could be influenced by GPs. During this time, the national reforms clarified the way forward and several members of the Action Learning Set became elected members of the emerging CCG. Others have become established partners in practice gaining experience through access to the former South Central Health Authority leadership programmes for CCGs, and through appointment to clinical commissioning lead roles in the CCG as well as in primary care provider development. The CCG has been able to engage GPs in commissioning in a range of ways – commissioning evenings, the primary care CQUIN, task and finish commissioning lead roles, clinical commissioning leads as well as its Clinical Executive roles. It has successfully seen a clinical commissioning lead get elected and step up to a Clinical Executive role and seen clinical leaders step into provider development roles in partnership with Solent NHS Trust. The CCG has worked with its COMPACT partners and NHS Improving Quality to put in place a year-long development programme focused around the NHS Change model for primary care leaders. The CCG has recognised the importance of talent management and succession planning and in response to this established during authorisation a Leadership Development Plan as part of its overall Organisational Development Plan. The latest iteration of this was approved in April 2012. In particular ensuring there was sufficient clinical leadership capacity and capability has been recognised as a very important part of the CCGs development. This has been re-confirmed in recent local and national surveys and other feedback from members.

3 Strategic Fit

The development of clinical leadership is very much at the heart of the CCG. In its statement of intent and strategic objectives we identify the need to:

‘enable our GP surgeries as members to engage and drive commissioning’ , and

‘develop the CCG as a mature organisation considered as credible and competent with the appropriate capacities and capabilities’


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One of our values is to be ‘clinically led’. In our Organisational Development Strategy we state a desire to focus on our developing our leadership and capacity to succeed, creating a system which attracts and retain the best people to work for us. We have been fortunate to build a strong clinical executive for the establishment of the CCG but we need to ensure that as clinical executive portfolios come up to tenure that there is a pipeline of talent waiting to step up to these roles, as well as developing clinical leaders working in others ways within practices and leading on specific aspects of commissioning.

4 National Research Nationally there has been much research looking at the matters related to clinical leadership talent management and the issues that need to be overcome. One such piece of recent research is the work undertaken by the HayGroup ‘Doctor Who? – The barriers and enablers to developing medical leadership talent’. In this research it was concluded that:

45% of medical; leaders do not intend to stay in their role for more than five years

Of those 14% do not intend to stay in their role for more than two years

58% of respondents had little or no confidence that successor arrangements are in place for clinical leadership roles.

When considering the challenges it noted:

The joint demands of managing a clinical career and workload as well as the leadership role

Medical culture and peer relationships

Short term tenure of clinical leadership posts

And when looking at the things which put medical leaders off taking on leadership roles the critical things identified included:

The demands on time mean they have to frequently sacrifice their external interests

Not being given the resources they need to get the job done

Lack of trust in management and/or the relationship with management is poor

Having to manage challenging colleagues

Rules and procedures are bureaucratic or unhelpful

Do not feel sufficiently financially rewarded for the role

Autonomy to get the job done is restricted

Organisation shows little interest in innovation and new ideas or in high performance

They do not know what is expected of them on a leadership role

They do not feel they have the skills to take on the job

The report suggests in terms of moving forward the following principles be considered:

Medical leadership roles should be realistic and in line with the realities of clinical professional life


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Going into a leadership role has got to be a positive career move for doctors. This means it needs to be valued by the medical community and not seen as impacting negatively on career progression or status

The real impact of clinical leadership needs to be publicised and supported to promote the value of the role

Development of leadership capabilities and conversations regarding the range of career pathways should start early and continue throughout

Focus should be on all doctors as leaders, as well as formal leadership positions.

5 Local Review

We commissioned an external provider to undertake a review of its current approach to inform its future arrangements during 2014. The review followed identification in our organisational development strategy (2013) a work programme of ‘Great leaders who make a real difference’ and a need to ‘established talent management and succession planning arrangements for both clinical and support roles’. To do this the supporting organisational development plan (2013) identified three specific actions:

Review best practice elsewhere to inform review of local arrangements

Use previously identified mechanisms to support clinicians in exposure to and development in commissioning e.g. buddying, mentoring, participation in task and finish roles, commissioning development programmes

Include revised approach into a revised Leadership Development plan/programme The reviewer was asked, in support of this, to undertake “a review of best practice elsewhere as well as undertaking a series of interviews locally to identify needs and possible solutions. A draft clinical leadership - talent management and succession planning strategy will be produced including tangible actions and deliverables.”

6 Interviewees and Research

A number of semi-structured interviews were conducted with a cross section of clinicians – some working with the CCG or members of the CCG and one trainee – these were either face to face or by telephone and email. These included:

GP Clinical Executives

Governing Board Nurse Representative

Practice Nurse Representative

Clinical Commissioning Leads

GPs involved in commissioning via ‘task and finish’ work

Other GPs

GP Trainee

Director of Professional and Clinical Development

The interviews were structured around the following headings:

Broadening the talent pool (GPs and primary care nurses)

How to engage: o What exists already o Sowing seeds of thought/interest early o Those in the City already

Freeing up – how?


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Collaboration between the 3 local CCGs

What should development look like/include?

How could the Deanery help?

How to retain talent? This semi-structured approach enabled consistency whilst equally allowing for the richness of individual experiences and ideas to be explored in greater depth in relation to the subject matter. Participant responses were then comprehensively reviewed and a thematic analysis undertaken. In addition the Director of GP education and Head of School and the Associate Dean for Educational Development, Health Education Wessex were also met with to explore how they might support the CCG in talent management. In research consideration was also given to best practice identified in East of England, London and Sussex.

7 Findings

The passion and energy with which most interviewees spoke was reported – demonstrating a strong sense of belief in their work with the CCG and a desire to use personal contact as an opportunity to explain, share and encourage others. There was a real feeling of ‘connecting, reaching out’ and doing this in a systematic way. The findings from the interviews and research has been summarised over 8 headings:

Succession planning

Broadening the talent pool

Task and finish approach

Combatting negative perceptions

What helps

Selling the benefits of clinical commissioning as a means of supporting retention

Development (Medical)

Development (Practice nursing)

The findings for each of these follows. 8 Succession planning

Those in Board level senior clinical leadership roles have a responsibility to identify their potential successor arrangements.

It is acknowledged that a competitive process would need to apply, however, senior leads should actively headhunt future talent using working relationships and networks as a natural identification opportunity, and most certainly an opportunity to stimulate interest in clinical commissioning.

The CCG risk management and business continuity plans which identify how key positions would be covered in the event of (a) short/medium term and (b) long term absence should be utilized for succession planning purposes also.

9 Broadening the talent pool

There were a range of findings in this area – separated into macro and micro levels.


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At a macro level: The RCGP, NHS England, NHS Careers and other national bodies could do more to promote clinical commissioning as a credible and realistic career choice. Commissioning should find its way into all clinical curricula in some shape or form. Sowing the seeds - an awareness of and interest in commissioning needs to be stimulated early on in a trainee’s developmental journey and at key points thereafter. It is not just about being a doctor, but about resources and how to plan their use. More locally Health Education Wessex (specifically the Deanery) is the obvious place to start with and this could be achieved through:

Appropriate inclusion of commissioning within all course curricula

Delivery of teaching session(s) by practicing clinical commissioners and those with senior leadership CCG roles

Informal lunchtime or evening supper talks to doctors in training (particularly GP trainees) by practicing clinical commissioners and those with senior leadership CCG roles to bring commissioning alive.

Events held at the Deanery ensure a captive audience, although this need not be the only venue. The Deanery also could be used as a swift and comprehensive means of delivering promotional material to trainees.

Appropriate inclusion of commissioning/commissioning scenarios within leadership and management programmes run on behalf of the Deanery by The Courses Centre (e.g. Lead or be Led, etc.)

Development of a Clinical Commissioning Fellowship embedded in CCGs and other local organisations

Talk to those on registrar year at one of their Wednesday sessions (run by GP Education, SJH)

Give registrars one week where they follow a CCG team/person/doctor

For the aforementioned to occur, educators, need to acknowledge commissioning as a critical skill that will be needed into the future as opposed to the misconception of having a lifespan contingent upon current NHS structures only. Consideration also needs to be given to what extent are locums involved as they are a source of potential talent. At a micro level: The CCG needs to maximize the talent that is already available to it, but perhaps untapped. The CCG can use its collective intelligence to maintain an overview of all GPs within Portsmouth City in order to identify who might be encouraged to participate in CCG work streams and in the case of newly qualified GPs/those new to the City, to introduce the CCG at a personal level and identify who would benefit from induction type support from a commissioning perspective. Using personal contact from individual Clinical Executive members was strongly favoured so the CCG is seen as reaching out to existing/new GPs, but also to proactively encourage individuals to get involved in work streams rather than leaving things to volunteer or application processes.


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Finding out what interests an individual and aligning this to possible ‘task and finish’ groups to encourage participation in work streams was seen as important. Similarly, invitations to Board or other informal commissioning meetings, or simply an invitation from one/two clinical commissioners to an informal dinner, which serves as an opportunity to share ‘what they do (as a clinical commissioner) and why they do it’. The sense of passion and commitment that was tangible in many interviews needs to be harnessed to create a continual buzz around commissioning. Consideration could be given to fund 6 sessions over as many months to get someone involved in any aspect of commissioning deemed relevant to their interests/development needs – this could include shadowing of a CCG lead and/or active participation in commissioning business. From an OD perspective, there was a desire to build loyalty amongst new GPs to the CCG. (Responses suggested there is a good level of loyalty to CCG senior clinical leads on the part of those interviewed.) Such loyalty could be engendered in other working relationships through CCG leads initiating personal contact, getting to know the individual and following this up over time. CCG reputation management is key in terms of organisational profile and attracting publicity for the right reasons (e.g. pro-active media management, show casing commissioning successes, profile of CCG and gaining awards, etc.). Appraisal process could include consideration of commissioning for those seeking extra challenge or wishing to acquire this skillset. Attracting young doctors was seen as key for the future – people not set in their ways, open to new ideas, enthusiastic, etc.

10 Task and finish approach Whilst acknowledged as a good means of engagement, it was acknowledged also, that these needed to be set up in a far more professional, effective way:

Ability to do bite size chunks of work that have been sufficiently scoped in advance (? by another GP)

A mentor or buddy from the CCG leadership should be assigned as a means of personal support

When developing task and finish groups, be very specific in detailing the project. Need clarity from the outset about outcomes to be achieved, and a clear end date determined from the outset also, so things do not run on and on as seems to happen on occasions

It is important to ensure clinical leadership/expertise is used appropriately as opposed to turning GPs into managers. Commissioning managers similarly need to understand how to involve clinicians appropriately so the partnership is effective. Both will have distinct roles, but ones that complement each other. It is important that clinical commissioners receive feedback on their interventions and achievements. GP appraisal is confined to general practice and so there is an absence of feedback on commissioning skill and ability.


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11 Combatting negative perceptions

Commissioning needs to be seen as a profession in its own right, an opportunity to acquire transferrable leadership skills/a unique skillset with global application. Commissioning is often perceived as ‘meetings’ or a ‘talk shop’ which is a turn off. It needs to be made practical. It needs to be seen as the most impactful way of leading, as opposed to the poor relation of the system. Its increasing future importance – irrespective of future NHS structures – needs to be understood. ‘Show and Tell’ and Awards events could stimulate interest in clinical commissioning. Running this alongside supper and/or a keynote speaker could increase attractiveness of attendance. Awards can be more attractive for doctors in training or newly qualified when they cover a larger footprint than a single CCG – giving more credibility to the c.v. Opportunities should be taken to proactively and succinctly communicate positive clinical intervention (e.g. the problem, the clinical commissioning intervention, what this did for patients in terms of maximizing quality, safety or reducing cost, increasing efficiency, etc.).

12 What helps A range of enablers were identified including:

Financial support (although backfill not always an easy solution)

Supportive partners to allow changes in work pattern at the surgery

Salaried doctors needed to be included equally with those in partnerships and can probably be more flexible

A dedicated resource as with a clinical fellowship

Paid time to sound out and nurture new talent

Federating

When practices merge, attention should focus on how the new structure and combined resources can support development opportunities (e.g. attendance at study days, development time and time for research). This should be factored in to the new running costs.

A belief that time invested will be personally rewarding and will benefit patients and/or working lives in a tangible manner.

13 Selling the benefits of clinical commissioning as a means of supporting retention

Attraction messages and promotional material could reflect what a number of clinical commissioners perceive as the benefits of their involvement:

An opportunity to network and getting to know more GPs and practices in the area

Potential career opportunity

Gaining a strategic overview that guards against insularity and silo working

A wealth of training opportunities (formal and informal)

A business opportunity

Enhancing the reputation of their Practice and their own professional practice

An opportunity to create a portfolio of interests


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An opportunity to make a real difference to patient care (safety, quality, cost reduction and efficiency)

The CCG offers the opportunity to have one’s ideas listened to and acted upon

All of the above need to sit alongside a narrative that clearly evidences how clinical commissioning has successfully made a real and much needed positive difference since this is the best publicity of all. Clinical commissioning lends itself to portfolio career opportunities. These are likely to be increasingly attractive in the future. Part time opportunities will be attractive to many, especially those with parental and other responsibilities (noting females being the dominant gender entering General Practice currently).

14 Development (Medical) It is important to provide safe ways of learning through doing. It would be helpful to produce a clearly defined pathway of development opportunities, so it is clear how/where things fit and the choices available. There is a need to create alignment (as far as possible) between Masters in Health and Wellbeing (Portsmouth University), Deanery programmes, GP Education, First Five Years, TARGET and Commissioning Leads evenings. Doctors are attracted to development that is recognised/accredited CPD and thus supports validations. (This may in future apply similarly to Practice Nurses given validation is being piloted amongst them currently). There is a need to create a pool of mentors that are easily accessed. This could also have combined arrangements, i.e. clinical commissioning mentor and senior management mentor simultaneously. The development of a scholarship or certificated programme that boosts the c.v would be attractive. (This could take the shape of including X amount of clinical commissioning sessions over six months, a set piece of work and skills training: recognising your style, how to manage/chair meetings, negotiating skills, dealing with difficult people). Where appropriate, e.g. working through a real life commissioning scenario, use of actors could aid development. There is a need for credible trainers/speakers that leave people wanting more. For example the Chief Operating Officer’s presentation on the commissioning cycle was well received and it being stated that they have the ability to make complex information more easily understood via an engaging delivery. Consideration could be given to providing a two-day introduction that covers all aspects of the workings of the CCG. Those that had attended ‘Lead or Be Led’ talked well of this development two days. Clinical Fellowships: Interest has been expressed in developing this – both as overt development, but also as a means of raising the profile of commissioning and attracting new talent. Possible areas covered include a blend of commissioning and Public Health. Alternative views are that such a Fellowship should cover in short chunks a wide range of the NHS, thus local level commissioning, higher level commissioning, (NHSE and Regional Office), experience of the provider system and shadowing a CCG Board member.


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Currently as far as fellowships are concerned, the Wessex Deanery offers three different arrangements:

The CCG offer and appoint a GP Fellow themselves and the Deanery link this in to their Fellows programmes to offer development support and coaching/mentoring etc. around the needs of the individual and the project. The Deanery would need funding support for this.

The CCG commissions the Deanery to appoint a GP Fellow as part of their Fellowship programmes to work fully for the CCG on this project. The CCG fully fund this and the Deanery would support and mentor them in their role

One of the Wessex GP Fellows undertakes as part of their role some work with the CCG but continues as a HEW Fellow working primarily on their own project.

In Wessex the Deanery have gone for a post Certificate of Completion of Training (CCT) Fellowship of 60% for 12 months, advertising to the current ST3 trainees due to finish at the end of July. The Wessex Deanery Fellowship is badged as Service Improvement and interest in developing this has already been expressed by another CCG in the area. Other models, notably that of the Deanery in East of England, are pre CCT (hence the doctor is still regarded as in training and the end of the fellowship should, therefore, lead to completion). In the East of England an overtly ‘Commissioning Fellowship’ exists. East of England have partnered with The King’s Fund and other national bodies, to produce a top class Fellowship experience.

15 Development (Practice Nursing) Practice Nurses would benefit from training on governance, professional accountability and safety. They need to increase their understanding of the business side of things. The current cohort undergoing training provide a useful opportunity to the CCG to help them understand the bigger picture and where things are heading for the future. There is a need to change mind-sets and help nurses understand that QOF and CQC are not about helping GPs boost income, but are about putting patient needs centre stage. The CCG could consider creating CCG awards for Practice Nurses. In addition it would be motivational for Practice Nurses if GPs observed their clinics periodically and used this as an opportunity for giving feedback/peer review. Practice Managers tend to deal with leave authorisation and team conflict issues, hence there is a gap for Practice Nurses in terms of meaningful feedback on clinical performance. The CCG could consider sessional support to the practice nurse representative or others to allow them to train up another trainer/link with practice nurses to replicate Portsmouth arrangement in neighbouring CCGs. It recommended that the CCG looks at nurse leadership development in more detail and separate from this work and in particular looks at:

Role and membership of the Practices Nurses Forum

Development of a register of interest and experience


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Succession planning for future practice nurse commissioning leadership roles

This programme of work will be led by the Practice Nurse Commissioning Representative and the Director of Clinical and Professional Development in conjunction with CCGs Governing Board Nurse Representative.

16 Focus for the future

Looking forward there is clearly much that the CCG could be considering in order to maximise the potential of its clinical leaders at all levels. As a strategy moving forward the CCG will have three work programmes:

our current Clinical Leaders

our clinicians in member practices

Future clinical leaders in training

The focus of each work programme can be summarised as:

Work Programme Focus

1. Our current clinical leaders A focus on our clinical executives and clinical commissioning leads to ensure they have the appropriate development and support to fulfil their roles and to maximise their potential for the future.

2. Our clinicians in member practices To develop as clinical leaders clinicians in member practices – to enable them within their practices, working across practices and engaging with the CCG and inn commissioning. Nurturing future CCG clinical leaders.

3. Future clinical leaders in training Provide opportunities for clinicians in training to understand and be interested in opportunities as clinical leaders and in commissioning.

Appendix one outlines the proposed specific activities planned.

17 Interdependices

This talent management and succession planning strategy is focused on supporting and developing current and future clinical leaders and maximising the potential in all clinicians as leaders. It interrelates to the CCGs existing:

Commissioning strategy

Operating model

Organisational development strategy

Governance and financial strategies, frameworks and plans

18 Resource Implications Delivery of this programme will be principally delivered by the Chief Strategic Officer, Chief Operating Officer and his team, and Clinical Executives, under the leadership of the Chief Clinical Officer.


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We will also seek to access support from NHS England and bodies such as the Leadership Academy who can provide advice, support and development opportunities to support our aims, often funded or at reduced rates. There may be aspects of the plan that will require external support. All such needs will be considered by the Chief Finance Officer to ensure affordability is balanced against the identified need before proceeding.

19 Programme and Risk Management Arrangements Delivery of this programme will come under the ultimate responsibility of the CCGs Chief Clinical Officer. However it will be led by a designated Clinical Executive with support from the Chief Strategic Officer and Director of Clinical and Professional Development. Risks will be identified and managed in line with the CCGs risk management framework and policy with significant risks being escalated through the Governing Board Assurance Framework. The clinical executive will oversee the review of performance against the strategy, making high level reports to the Governing Board as appropriate.

20 Conclusion

The CCG must ensure it has a strong focus on clinical leadership arrangements, both supporting the current but also nurturing the future. This will ensure the CCG continues to progress and grow and deliver its vision for the future. Approved by: Governing Board Date approved: 21 January 2015 Document Owner: Chief Strategic Officer Review Period December 2020

TS/09.02.15 G:\PCCG - Business Development\Organisational Development\Leadership & people development\SUCCESSION PLANNING\Clinical Leadership Talent Management and Succession Planning APPROVED GB 21.01.15.docx


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Appendix One

Clinical leadership – Maximising Potential: Specific Activities

Work programme One: our current clinical leaders

Description Specific Activities

A focus on our clinical executives and clinical commissioning leads to ensure they have the appropriate development and support to fulfil their roles and to maximise their potential for the future.

Ensure every clinical leadership role has a clear role description and terms of appointment

Ensure every clinical leadership role receives an annual appraisal, agrees an annual development plan and has agreed objectives

Meet identified development and support needs

Ensure individually and collectively the clinical executive and clinical commissioning lead portfolios remain fit for purpose and cohesive

Work with delivery partners such as the Leadership Academy to be aware of, promote and access offers from them – national core programmes and locally led interactions

Put in place team development activities (broaden to include Governing Board and/or senior managers as felt relevant) to focus on their organisational development, team building and ways or working.

Utilise tools such as 360 feedback, coaching, mentoring and team development (MBTI etc.) to develop as individuals and a team

Put in place to meet identified technical skill gaps either collectively (where collective need identified) or individually.

Work programme Two: our clinicians in member practices


To develop as clinical leaders clinicians in member practices – to enable them within their practices, working across practices and engaging with the CCG and inn commissioning. Nurturing future CCG clinical leaders.

Utilise practice visits to promote clinical leader roles and identify support to interested individuals

Appoint a clinical executive to co-ordinate and ensure timely responses to those expressing interesting with an offer of ways to get involved and find out more

Develop a ‘shadowing experience’ or ‘taster sessions’ as an offer to those expressing interest to find out more

Appoint a clinical executive to work with ‘task and finish’ commissioning leads to lead on talent conversations, mentoring and evaluation of arrangements. As part of this talent spot opportunities for future clinical commissioning lead portfolios or clinical executives.

Develop a register of special interests and expertise across member practices


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Invite ‘task and finish’ commissioning leads to feedback to Clinical Executive about their experience and the impact it has had

Develop range of opportunities to get clinicians in member practices involved in commissioning through a blend of CCG business needs and individual areas of interest

Consider development of a portfolio approach to attract new GPs who are looking for such an approach to their careers. Consider the salaried GP option as a possible mechanism.

Consider mechanisms within the CCG to support GPs to get involved and have the capacity to do so.

Clinical Executives to develop a clear compelling narrative as to what they love about their leadership roles and why others should consider them

Work programme Three: future clinical leaders in training


Provide opportunities for clinicians in training to understand and be interested in opportunities as clinical leaders and in commissioning.

Develop relationship with lead for GP registrars

Develop an offer to present to registrars – presentations as part of training time, shadowing experience package based around uncommitted training days

Develop an approach to the ‘first fives’ (first five years post qualification engagement) – consider opportunities across the COMPACT

Get GPs actually involved in commissioning to deliver training about commissioning and clinical leadership roles

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Clinical Leadership Maximising Potential Talent Management ... Leadership Talent... · Clinical Leadership – Maximising Potential Talent Management & Succession Planning Strategy