Why Clinicians will manage the NHS better
The NHS has the least clinical involvement in management of all national health services. The perceived wisdom is that by involving clinicians, the efficiency and effectiveness of the NHS will improve. The contribution which clinicians should make to management is undoubted, but many have voiced doubts that a sufficient number of them possess, or want to learn, the required management skills to fulfil the roles anticipated for them in the Health and Social Care Bill.
During the discussion it was said that of the leaders who had come from clinical backgrounds, there seemed to be a predominance of nurses, and they may have bought into the management way of doing things, as opposed to stimulating innovation using their clinical knowledge. Also, was it a fair accusation to say that GP managers would be micromanagers, and would struggle to manage populations as opposed to their practice list?
am sorry I missed the discussion. My own experience is as lead manager of a big, successful and rapidly expanding inner city practice and a “voice” in our local network of practices (managers still excluded from formal board membership in this particular cave!). I would agree that nurses tend to be the innovative clinical leaders, but what they have had to buy into is deference to the status quo doctor led establishment, not the “management way of doing things”. GP doctors meanwhile do try to micro-manage, “sweat the small stuff” and generally make it much more difficult than it needs to be.
I have had one or two queries about the formula that I used as a platform for the remarks on wednesday. It comes from a theory by Leonard Nadler about identifying learning needs and is simply – P (expected performance) minus K (what one already knows eg as demonstrated by ones qualifications and knowledge) plus D (what one already can do and does (eg ones competencies and behaviours) equals N (the learning need to fill the gap and achieve the expected performance). P-K+D=N.
The conclusion of the debate I guess was that clinicians will bring a relevant and helpful skill set to the leadership challenge ahead of the NHS; and that this will add to and complement the skill set of the existing management community; but that both together is unlikely to be sufficient without some reorientation,training and development to achieve the outcomes we are seeking. In summary we need all of these skills and more to achieve, and the debate about one set versus another is sterile.
People mistake the background of the manager with the function we expect the manager to carry out. Great management and leadership is about creating the right context to enable great clinical care to be delivered. It doesnt matter what the background of the manager is.
Poor management thinks its role is to manage docs, and again it doesnt matter what the background of the manager is.
While we agreed that the NHS needs, as with all things in life, to achieve a healthy balance which in this case is a mix of clinicians (in all their guises) plus “professional” management, we also questioned whether the Bill in its current form achieved that balance.
A very useful evening, thanks Justin. If we had confidence in the composition of the decision making/fund allocating bodies (in all their various guises), then the proposals would be received in a more positive way. One idea might be to actively recruit retired GPs into the CCGs to deliver experience and wisdom. Certainly a determined campaign to recruit the ‘Best of Breed’ is vital.