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03.06.15

Managers have too much say in clinical decisions – Scottish doctors

There is “strong dissatisfaction” among senior doctors in Scotland about the impact that non-medical managers and red tape has on clinical decision in the NHS, according to a new survey.

The research on the changing experience of the work of consultants in NHS Scotland was conducted by academics at Dundee and Glasgow universities.

Based on interviews with consultants and a follow-up survey, it found that doctors felt decision-making rationale in their workplaces had tipped too far towards a business model at the expense of medical professionalism.

It found “extremely high” levels of frustration at the lack of opportunity to speak out on behalf of patients and services, to influence change and improvement, and to participate in decision-making over issues that directly affected their working lives.

Consultants north of the border are also concerned about the increased influence of non-medical managers in setting clinical priorities. The survey shows this has had a detrimental impact on consultants’ perceptions of their professionalism and autonomy.

The report said: "While the NHS has always had to accommodate potentially conflicting rationales, consultants felt that the balance had 'tipped too far' towards business and financial decisions dominating how work was organised and evaluated, and that such a trend was inconsistent with effective and efficient patient care."

Professor Graeme Martin, of Dundee University, lead author of the report, said: "The consultants we spoke to complained that pressures in the system were causing significant problems for patient care.

"We also found evidence of strong dissatisfaction with the impact of non-clinical managers and bureaucracy in clinical matters."

BMA Scotland consultants committee chair Nikki Thompson said the research confirmed that consultants were overwhelmingly committed to the NHS and to patients.

But she added: “[The research also] demonstrates the overriding sense of frustration among consultants at the focus on political or financial priorities in the decision-making process.

“It is so important that the health service respects and responds to medical professional judgement, so that as consultants we are able to steer and develop the services we provide to meet the clinical needs of our patients.”

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