Poor representation of women on CCG boards needs fixing

General practice has long been seen as a more attractive career option for women than some other specialties, and this is reflected in the fact that 46% of general practitioners (GPs) are women.1

But an analysis done as part of the BMJ’s investigation into the make-up of clinical commissioning group (CCG) governing bodies shows that just 22% of GPs on the boards of CCGs are women.2

The analysis examined almost 2500 board positions across 176 shadow clinical CCGs. Just 19% of these groups are chaired by women, and, when lay positions and other clinical roles on CCG boards are taken into account, women make up just 37% of overall membership of boards.

Women GP leaders believe the findings show that urgent action needs to be taken to encourage more women to take on leadership roles in the health service. Health minister Lord Howe recently described the shortage of women in senior NHS leadership roles as a “serious and significant issue” that needed to be tackled.3

Penny Newman, a GP and consultant in public health in Ipswich and primary care adviser to NHS Midlands and East strategic health authority, produced a report for the NHS Leadership Academy in 2011 examining the shortage of women in leadership roles.4 She says the lack of women on CCG governing bodies is the result of a range of factors, including a prevailing “old boys’ network.”

“The mindset of some CCGs is a bit like a club,” she says. “[GPs] went straight from practice based commissioning to the new governing body, so they are well known to each other.”

Newman believes the fact that women are less likely to be practice partners may contribute to low numbers of women on the boards of commissioning groups. Just 39% of partnerships are held by women doctors, compared with 70% of salaried posts.

“If you’re a sessional GP, you often don’t even have a vote, let alone a look-in in terms of the board,” she says. “So there is a bias against sessional GPs, the majority of whom are women.”

Overall, Newman believes the situation is the result of a “combination of personal and organisation factors.” She says, “There is a cumulative disadvantage from lack of ambition, juggling career and family, a lack of role models, and organisational bias. This means women are not only less likely to put themselves forward, but also less likely to be taken into the leadership roles. That’s a real problem because you’re not bringing our leaders on.”

Newman says positive steps are being taken, such as the establishment of a national task force on women in medicine and a group being set up by the NHS Commissioning Board to look at CCG diversity.

In the short term, she says, CCGs must do more to ensure their organisations are inclusive. “It’s really worrying that with CCGs, we seem to be going backwards, despite the significant number of female GPs who could be current and future leaders,” she warns.

“We are not asking for people without the talent to be at this level, we are asking for people with talent to be considered,” she adds. “We are asking CCGs to make sure that they have proper appointment processes, that it isn’t a club, that it’s open to everybody, and that they think about developing the talent and having the right people on board. Given the proportion of women in general practice, if they haven’t got any women on there, you would be really worried.”

Newman also warns that having non-medical women on boards could lead to a “false sense of security.” She says, “Having female nurses and managers masks the lack of female medical leadership.”

Sara Khan, a GP in Hertfordshire who is involved with her local commissioning group, says she has not personally encountered barriers to participation. However, she agrees that more needs to be done to mentor female GPs who may want to take on leadership roles.

“Clearly there is a problem all over the country,” she says. “I personally believe there should be support available and a mentoring scheme put in place specifically for GPs who would like to pursue leadership roles.”

She adds: “You may find that more males want to be involved in this than females. A lot of my [female] friends and colleagues who are GPs are really not interested in medico-politics.”

Clare Gerada, chair of the Royal College of General Practitioners and a GP in south London, agrees that some women would prefer to “spend time seeing patients.” But she says giving more consideration to details such as when meetings are scheduled could encourage more to take on leadership roles.

“It’s the old fashioned things, like acknowledging that evening meetings are difficult for women,” she says. “You may need to look at breakfast time or daytime meetings. It’s all stuff which was always thus but has never ever been addressed.”

Gerada says the composition of CCG governing bodies represents a “significant skew” that needs addressing. “It’s sad but reflects what’s going on overall in women leadership positions,” she says.

“There’s fewer and fewer of us and we’ve gone backwards over the last 15 years,” she adds. “Unless we have women right through the ranks there are no role models coming up.”

But Gerada does not think women should be co-opted onto CCG boards. “I’m not in favour of affirmative action,” she says. “Most women would rather get there on merit.”