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17th December 2015

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Failing

News and Comment from Roy Lilley

Last week the CQC's chief inspector of GP-land, Steve Field made a really good job of insulting his GP colleagues. The outcry was predictable. A profession under the pressure that GPs are under are not best encouraged to up their game by someone, of Field's standing, telling them they have failed as a profession.

Condemnation was universal. However, the Tinkerman took to Twitter and elsewhere to call Field courageous, needlessly bringing himself, once again, into conflict with doctors. Courageous? Brave? Bold, plucky or foolhardy! Ill-judged and imprudent, maybe?

To be critical of Field's calumnies is not to disavow the importance of improving quality.

I heard Field had offered to resign but was cajoled to soldier on? I'm guessing, the embarrassment and disruption of his going outweighed the awkwardness caused by his staying.

Field's stupidity, for there is no getting away from it, it is stupid to insult the profession you are trying to encourage to do better, masked some
good news about general practice.

It is to have a funding boost of at least 4% every year over the next five years to cover the 'changes in GP workload', and will update the antique Carr-Hill formula, used to allocate funding to individual practices.

The Carbuncle said the budget for general practice will increase to �7.65bn. All of that was drowned out by Field's self-inflicted cacophony.

I bet the DH press office was delighted with Inspector Field. It's not often they have good news and when they do...

What we are seeing here are text book examples of what Norman Pickervance calls disconnected management. It is common among mangers who see their role as being 'in control', they migrate into imperiousness.

In this case the clue is in the title; 'Inspector'. Examiner, overseer, judge. It implies superiority, supremacy, when what is needed is consent, collegiate and sharing.

As far as I know, Field has no management qualifications but sets out to tell his colleagues, many of whom are vastly more qualified and experienced than he, how to go about their job.

To achieve that he must employ the techniques of comparison, measurement, inspiration and a vision of something better. From that platform create a well of goodwill to draw upon for authority, becoming a leader by consent.

Disconnected leadership is something for us all to avoid.

I have never met a leader who could not benefit from spending more time with the people they lead. Leaders must create the time and space for good people to do great things. There, I've said it again.

It is too easy for leaders to become disconnected; if they are mainly concerned with poor performance they assume everywhere is bad. Instead of seeking out and showing poor performers the good stuff and how to do it, they focus on the poor performer's bad stuff, call them stupid, insult them and bully them.

Sometimes, so-called 'leaders' have no idea how to go about improving performance but are too pompous to admit it and their frustration gives way to intemperance.

The second disconnect is the fearful leader. A fear of revealing shortcomings, mistakes, failings, limitations, weaknesses. When poor performance crowds in, the fearful leader turns inwards. They become paralysed, dysfunctional.

For example; fear of inspection and its consequences, or perhaps the obverse... fear that inspection has changed nothing in 16 years, might make fearful leaders freeze. Become reclusive. They can't see a way out.

With nowhere to go, to share their failings and look for answers, they stay put, paralysed until they are shoved out. Hence a third of ChEx posts are vacant and the average tenure 27 months.

And the final disconnecter; the unmindful leader. Rather than do the job the way it is supposed to be done, they redefine what they would call 'the right thing'.

If they recruit people they tend to overlook their errors in case it reflects on them. They lose objectivity; don't assess the impact of what is happening. Blind loyalty when the reality of the moment calls for action. In consequence they lose their authority. People see them as disconnected from reality... weak.

So, if you are studying for a Masters or MBA you may have the 'How Not To Do It' song-book from one week in the life of the NHS!

But, amongst all that, let's try and remember GPs have a few more quid to work with and good luck to them... even the ones who are failing!

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