GP consortia: navigating ambiguity to produce greater public value?

The UK's NHS is about to be significantly remodelled according to a white paper published in July 2010 that outlines the devolution of commissioning responsibilities away from strategic health authorities and primary care trusts to consortia of GPs, which are to be established at local level. Details of how the new GP consortia will operate are as yet unclear, but in essence they will be strategic alliances and it is likely that they will develop more or less formal arrangements between consortia partners, such as those of a commercial joint venture. This article draws on primary research into strategic alliances between organizations in all sectors. It suggests that there can be significant challenges for those working within strategic alliances, given that these tend to be beset by ambiguity and political tensions. In a context of ever greater transparency and accountability, it will be crucial to attend to the human aspects of strategic alliances since these represent significant risk if neglected. Conversely, alliances also offer the opportunity to develop the synergy of people, organizations and communities to deliver greater public value. Successful collaborations need to get three things right: governance, operations and behaviours. Relationships between consortia partners have a significant bearing on their ability to deliver desired outcomes. They must be able to build and maintain trust. Consortia partners will need sophisticated negotiating and stakeholder management skills and must be able to engage the public in setting the strategic goals for which they will be accountable. They also need strategic and operational management skills and must be able to cope with ambiguity and manage complexity. This paper argues that specific forms of leadership are needed in collaborative arrangements to mobilize people for positive action. People must work together by willingly and effectively pooling their initiative and expertise, and create a product or energy that is greater than the sum of their parts. The nature of leadership required to produce such high performance outcomes is likely to supersede leadership that is the result of structural relationships or of individual action. In particular, distributed leadership is likely to be relevant.