As general practitioners take the lead on commissioning for the NHS in England, a qualitative study of GPs and managers from four primary care trusts (PCTs) reports that active management of disparate groups leadership is a success factor, and that organisational processes may be a hindrance.

The team from the School of Community-based Medicine, University of Manchester examined the behaviours adopted by managers responsible for commissioning hospital services, and explored the impact of these behaviours.  41 in-depth interviews were conducted with managers and GP and both formal and informal observations were undertaken (150 hours).

The study reports that managers adopted many managerial behaviours familiar from the literature, including sharing information and networking (within the organisation and externally). This activity was hindered by multiple organizational layers and unclear decision-making processes.

Some managers who were responsible for facilitating practice-based commissioning were seen to adopt a managerial approach that the team termed as being an ‘animateur’ – meaning the active management of disparate groups of people over whom the manager had no formal authority. This mode of working appears to be a factor in determining success. It was more prevalent where managers were seen to have legitimacy, and was facilitated by managerial autonomy. However, certain organizational practices appeared to inhibit the development of this approach.

The authors suggest that managers of the new commissioning organizations will require a deep and contextualized understanding of the NHS. The team concludes that it is vital that organizational processes do not inhibit managerial behaviour and note that legitimacy may be an issue in situations where managers are automatically transferred from their existing roles.

Checkland, J. et al. ‘Animateurs’ and animation: what makes a good commissioning manager? Journal of Health Services Research & Policy. 2012 Jan; 17(1):11-7. [PubMed abstract]