'The NHS needs doctors firing on all cylinders, not retreating to their duvets'

Doctors, you would think, have never had it as good as under this government. There are more consultants than ever before, a third more funding for the NHS, and significant pay rises for most.

And the devolution of funds to primary care trusts has given GPs unprecedented ability to control their own destiny (not to mention the destiny of their hospital-based colleagues).

Yet it would seem that within the doctor camp, morale is at an all-time low. According to a doctors.net poll of more than 3,000 doctors last month, only one in 10 thought the extra money given to the NHS had been well spent. Less than a third thought there had been any improvement in the NHS since 2002. And only a third envisaged working to normal retirement age within the NHS.

So what is the matter? Is this just another case of doctors being curmudgeonly? Or is it something more profound that the government would be foolish to ignore?

Jon Katzenbach, a management specialist who has spent his working life studying what motivates people in the workforce, would almost certainly argue the latter. The doctors.net survey is only the latest in a series of pieces reflecting the prevailing level of medical misery, a mood that will lead to much greater trouble in future if leaders do not wise up.

The issue is not pay (some doctors privately think they are now paid too much), but doctors' raison d'être; what they are here for.

In his book Peak Performance, Katzenbach argues that different kinds of occupational groups are motivated by different things and need different management paths. He identifies five groups.

The first is motivated by mission, values and pride. People in this group typically work in highly engaged teams, like marines. They are less motivated by money for its own sake and by meeting external targets than by a strong sense of purpose and value-driven leadership. While they are rarely individual risk-takers, they are often willing to sacrifice themselves for the team and the group's mission.

The second group is motivated by process and measurable outcomes. These people can be found in workplaces where consistent quality is paramount, such as manufacturing industries.

They delight in meeting numeric targets and goals. They do not necessarily mind that they did not set these goals themselves. These are people who are genuinely excited by the idea of payment by results.

The third group is entrepreneurial. They love high-risk, high-reward work and care about ownership of what they do. They include market traders and leaders of high-risk industries.

They don't need social recognition so much as a sense of personal risk-taking and material reward. They are often willing to lose everything to follow their personal dream. These people are rarely found working in the health service.

The fourth group cherishes individual achievement. Those in it need to be able to see opportunities and incentives to give them a sense of personal achievement and progression. Many professionals, who readily endure years spent qualifying for the sense of achievement it gives them, fall into this group.

The fifth group cares most about social recognition and celebration. People in this group don't like taking risk; they are not as bothered about pay unless it slips beneath a decent minimum, but they do care that their special effort is acknowledged by the group. They tend to work as employees in large organisations that rely on consistent customer service and relatively low-paid staff, such as fast-food chains and retail banks.

While you might take issue with Katzenbach's groupings, the main point is his observation that different people get out of bed - and retreat to their duvets - for profoundly different things. This is what is at stake for NHS doctors.

Using Katzenbach's framework, I think doctors mostly fall into groups one and four. We are taught to remain loyal to our colleagues and to sacrifice a lot - our youth, our sleep, the other paths we might have taken - for our profession and our patients.

To become a doctor, you also need a strong sense of individual achievement to endure nearly 20 years of gruelling tests of individual knowledge and skill.

By contrast, doctors are definitely not from groups two, three, and five. Doctors are rarely personal risk-takers; they would be offended by embossed 'doctor of the month' signs on the ward, and nothing seems more idiotic to them than some externally imposed measure that they cannot make personally meaningful, either within their team or their individual career path.

So what to do? So much of the rhetoric of reform is couched in terms of externally imposed political and financial targets that leave most doctors flat.

That's not to say that such targets are not important, but they are no way to motivate most doctors.

Large, abstract goals set by others, which might rally people in groups two or five ('let's reduce waiting times by 20 per cent!') seem vacuous for groups one and four, unless they are personally engaged in setting and meeting them for themselves, their teams or their patients.

The NHS needs doctors firing on all cylinders, not retreating to their duvets. Like marines or directors of professional law firms, doctors are intelligent, big people capable of doing great good. And they can create great havoc if their needs for achievement and meaning are not met.

In a recent editorial in the Journal of the Royal Society of Medicine, Dr Kamran Abbasi asked what role the world would like doctors to adopt. It is a question that I think health leaders would do well to ask themselves, before the current malaise among doctors takes a more destructive form. -

Dr Anna Donald is chief executive of healthcare information provider Bazian