comment: Managers and clinicians must find shared ground - and build on it

Published: 21/11/2002, Volume II2, No. 5832 Page 17

This week HSJ joins with the NHS Confederation, the British Medical Association, the royal colleges, the Institute of Healthcare Management and the British Association of Medical Managers in working towards a better, more sustainable working relationship between doctors and managers (news, pages 4-5).

Doctors and managers see patient care from different perspectives. Rightly, doctors have the care of the individual patient uppermost in their minds. When that care is impeded by a broader initiative, they - understandably - complain. Managers naturally and correctly see patient care in terms of systems designed to bring the greatest good to the greatest number. Both views are key in producing an effective and humane health service. Resolving the tensions between the two is equally vital.

Managers and doctors also have distinct views on targets. Managers believe there are too many targets and that they frequently conflict with one other, are insensitive to local demands and implemented too rigidly, and that the penalties for failure are often too harsh, but unlike doctors they intuitively understand the need for them, because they see them as useful tools for focusing on priorities.

Commission for Health Improvement chief executive Dr Peter Homa (HSJ interview, pages 18-19) says that CHI's reviews have identified only a few isolated examples of the distortion of clinical priorities through an over-zealous approach to meeting national targets. CHI's work could be exhibit 'A' in any attempt to convince doctors that working to national targets is not an inherently bad thing - therefore removing a major irritant in the relationship between managers and clinicians.

It was suggested at a BAMM conference in Dublin last week that the rejection of the consultant contract was, in fact, a much-delayed reaction to the introduction of modern management to the NHS inspired by the 1983 Griffiths report. But this is surely not the case. Most doctors realise that a service as complicated as the NHS needs good management. What they have not accepted is that this good management should directly impact on the way in which they work. Professor David Hunter argues their case this week (University challenge, page 15). Doctors must be 'truly put in charge', he suggests.

The problem is, however, that few frontline doctors want to be involved in, for example, workforce planning, tackling financial deficits or the number-crunching side of commissioning. All of these issues, of course, impact on patient care.

Managers must work harder to understand what drives their clinical colleagues, challenge them where necessary, but then develop systems which are sympathetic to the needs of the individual patient. Doctors need to acknowledge that managers are equal partners in delivering good-quality patient care. They will be in a much stronger position to tackle the government over targets if they do.

HSJ will bring you more details of the work being undertaken by the confederation, the BMA et al as they emerge. We will also contribute where and when we can to this significant initiative.