How doctors could help the NHS

Many would argue that the issue of involving clinicians in management has always been on the NHS management agenda and no health service insider would claim original thought by saying their insider knowledge could be of benefit. However, it wasn’t until the Griffiths Report that any concerted attempt at creating a management agenda for health care was suggested and subsequently adopted by Guy’s and St. Thomas’ Hospital in London in the late 1980s as a way of involving doctors in this process. Yet, despite this, over the past 30 years there has been some reticence amongst clinicians to become involved in what are often seen to be ‘administrative’ duties.

Cyril Chantler , an early pioneer of the clinical directorate model and a doctor-manager of some renown, once said that even with advances in medical technology, doctors have never been able to do so much for patients, yet their public image has never been at a lower ebb.

Furthermore, doctors’ involvement in management has a lot to do with their relationship with non-clinical managers who are responsible for implementing government policy which has become, over the past eight years, strongly directed at modernising the health service and gaining maximum value for money out of those who operate in it.

Professor Jenny Simpson, another who has done much to push forward the role of doctors in management, has characterised the clinician dilemma as such: the “involved” clinician, therefore, sits between two systems, one of which is the collegial, professional world, where he or she sits as a peer to colleagues with a set of specific clinical skills, governed by professional standards, codes of practice and ethics, whilst in the other, he or she sits taking a wider view of the organisation, mapping out its future track based on clinical knowledge and experience, with managers who are accountable, ultimately, to politicians.

So what is to be done? Findings of a small-scale 2005 study revealed a number of factors that build upon well-established themes. The study was interested in capturing and understanding the issues that lay behind clinical engagement, with specific focus on the skills and standards required to allow doctors to take on management roles; the interests and career factors that may persuade them towards these roles; the impact their current role and time pressure played in their willingness to be involved; what they thought about potential conflicts with colleagues and finally, resource management and organisational concerns.

The research concluded that doctors firmly wanted to be involved in making management decisions in the NHS because of their expertise in the field. They were also keen to see non-clinical managers gain a better understanding of the clinical viewpoint to help make better decisions. Despite this real willingness most doctors were unlikely to become involved in NHS management because they did not see it as their area of expertise and there were unanswered questions over whether their role should be a management one or more focussed towards leadership.

Alarmingly for anyone interested in progress on this issue, a number of authors had – over a decade ago – previously laid out the key areas where efforts regarding training and development for doctors could be focussed. Respondents to this study also wanted management-specific training and development. This should be set up more formally in all NHS organisations and formal career paths could also be introduced, although the blueprint for this should emerge from the training and development that is undertaken at the organisational level and within that specific context.

The evidence would suggest that there are currently a minimal number of “real” clinician managers in the NHS – the ones at every level who will support the spread and sustainability of change so that it is always focussed on improvement. Yet, despite this and many other studies revealing a real willingness amongst doctors to be consistently and actively involved in decision making in the NHS, not enough are being supported to do so. It is time for senior managers and leaders in the NHS to grab hold of this and – with their clinical colleagues – bring about some much needed change.

Simon Moralee is senior lecturer in Health Care Management at De Montfort University Leicester

References Chantler, C. (1999) National Health Service: The role and education of doctors in the delivery of health care The Lancet, 353: 1178-81 Simpson, J. (2000) Clinical Leadership in the UK Health Care and Informatics Review Online, 4 (2) Moralee, S. (2005) Involving doctors in management: key concepts and challenges for today’s NHS. University of Birmingham Gatrell, J. and White, T. (1996) Doctors and management – the development dilemma Journal of Management in Medicine 10: 6-12; Buchanan, D., Jordan, S., Preston, D. and Smith, A. (1997) Doctor in the process: The engagement of clinical directors in hospital management Journal of Management in Medicine, 11: 132-56