Published: 21/11/2002, Volume II2, No. 5832 Page 4 5

The NHS Confederation and the British Medical Association are today launching a project which aims to build a 'concordat' between doctors and managers in the wake of the rejection of the consultant contract.

The joint initiative, supported by HSJ and the British Medical Journal, and involving the royal colleges, the Institute of Healthcare Management and the British Association of Medical Managers, aims to develop better relationships and trust between medics and managers.

It hopes to agree a national concordat - setting out a shared vision for the relationship based on a recognition of the importance of collaboration and joint-working for patient care - in the new year.

The joint project is also planning a programme of work to define a new 'psychological compact' between doctors, their employers, government and patients.

One of the reasons cited for the rejection of the consultant contract was that consultants feared undue control of their work by unsympathetic managers.

However, anecdotal evidence seemed to suggest that many consultants had generalised worries about managers, rather than specific concerns about their own managers.

A summit meeting is planned around February to bring together all the organisations to discuss what can be done to improve relationships and to agree a programme of work.

NHS Confederation policy director Nigel Edwards told HSJ that there was a need for initial research to understand if there really was a problem, and if so what could be done about it: 'It is about mutual understanding.

What are the reasons doctors feel disenfranchised? To the extent it is real, what are the causes?'

Mr Edwards said work the confederation had done with colleagues in the US had suggested that simply starting to discuss these issues was a very good first step to getting clinicians engaged.

He said a concordat signed by those representing doctors and managers could make a difference.

He said: 'Some of these issues run very deep. Getting people signing up could go some way to dealing with it. It is probably the first time there has been that discussion about how the medical and management communities work together.

'There are things we can do, and they are about getting doctors to control their working environment. I was talking to a couple of consultants recently, and they obviously felt totally disengaged.

They had no idea of how to engage their organisations.'

BMA chair Dr Ian Bogle said:

'The clear rejection of the contract by consultants in England and Wales has revealed the urgent need to improve relationships between managers and doctors where these have broken down or threaten to do so.

'Many factors combine to make the relationships between doctors and managers difficult. It can simply be the pressures on both groups who are trying to juggle competing political targets in a service working at full stretch.'

NHS chief executive Nigel Crisp told HSJ he thoroughly endorsed the joint work and that the Department of Health is currently working on improving engagement with primary care trust clinical leaders.

Mr Crisp has recently held a series of four meetings around the country for the chairs, chief executives and professional executive committee chairs of PCTs to discuss these issues, and he said similar efforts were needed to ensure attention is given to the role of trust medical directors.