Safia Debar and David Colin-Thomé on the manager-clinician divide

Dr Debar on NHS managers and clinicians

In medical school and subsequent training, the views clinicians hold about NHS management are generally not complimentary.

Indeed, we are brought up in an “us” and “them” culture where working towards a common goal can be hard to envisage.

“A sea change is required to shift the culture of many clinician”

Top down targets, rotating medical managers unfamiliar with doctors’ roles, healthcare professionals viewed as resources, budgets and bureaucracy: these are the things clinicians often associate with the Department of Health.

And primary care czar? I was as unfamiliar with the concept as I was with the intricacies of the DH.

Management insight

However, meeting my mentor, Dr David Colin-Thomé, has not only given me an insight into the DH but also a clear overview of future plans for the NHS. Being the national clinical director for primary care, part of his role is to implement the primary care elements of the NHS modernisation plan. I was able to shadow Dr Colin-Thomé at the DH and attend a primary care conference where he spoke.

His presentation was about the next stage review and was aimed at GPs. As expected, this topic generated lively debate and a sense of discontent emerged in the audience. It highlighted the need for good clinical leadership in the NHS as well as a change in culture.

The presentation has stuck in my mind. It represents the turning point in my thinking as it has given me another dimension to consider. I now feel more balanced in my views about the NHS.

Looking ahead

I hope to continue to see the world from different perspectives. I think a better understanding of both sides would be useful for any trainee and certainly my mentoring experience so far has proved invaluable. Changing times in general practice are ahead, but this is not a new scenario. Innovation and adaptability are important tools for survival but retaining the core essence of the profession remains the challenge.

Although I still have concerns, namely the career structure and progression of trainees and newly qualified GPs, I am excited and optimistic about the future. The aims set out in the next stage review cannot be argued against but the main test is in their implementation. Time will tell.

David Colin-Thomé on working with Dr Debar

Meeting and talking to Safia Debar has been both refreshing and a reality check for me.

Though full of energy and aspiration, she initially held some negative views about the policy direction for primary care.

As Safia implies, much of this is driven by misinformation and misconception. But I feel there is often another dimension to some clinicians’ negative views and behaviours - namely a reluctance and often antipathy to transparent accountability, whether to patients, the public or their funders.

So there is a lot to do in the area of clinical engagement and a sea change is required to shift the culture of many clinicians if we truly wish to be leaders. The mentorship scheme is a great way to have a dialogue with and provide support to our aspiring leaders.