comment: Not to succeed would constitute a betrayal of the public

Published: 27/03/2003, Volume II3, No. 5848 Page 17

There has been a breakdown in the relationship between doctors and managers and those leading the service at a national level.'

The words of a British Medical Association representative or opposition politician? No, the view of chief medical officer Professor Sir Liam Donaldson in this week's HSJ Interview (pages 20-21).

But is he right? Some 71 per cent of the managers who responded to HSJ's survey suggested that relationships with doctors in their organisations are either 'good' or 'very good' (pages 14-15).

The answer is that both Sir Liam and those readers who responded to our survey are correct. Doctors do have profound concerns over the loss of autonomy created by a more managed health system and tightening professional regulation. They also worry about specific management policies - often driven by government targets - interfering with the clinical decisions they and their colleagues make on a daily basis. As a result many medics have failed to engage with the government's reforms - most spectacularly over the rejected consultant contract.

However, across the country managers and doctors are working together to improve patient care. Sometimes this innovation has been given momentum by the reforms that make many clinicians so nervous. Examples of this - often inspiring - multidisciplinary work can be found on pages 28-33.

Managers and doctors need to work together to deliver patient care in the most effective way. As NHS Confederation policy director Nigel Edwards explains (page 18), their different perspectives are crucial to success. This is why we decided to dedicate simultaneous editions of BMJ and HSJ to the subject of how doctors and managers relate. You can read a summary of the BMJ articles on pages 26-27.

Today a summit organised by the confederation and the royal colleges will address the issue - BMJ and HSJ will be there and contributing the views of our readers.

In this week's BMJ, editor Dr Richard Smith writes: 'Doctors are losing out in modern healthcare systems because of their discomfort with leadership, strategy, systems thinking, negotiation, genuine team working, organisational development, economics and finance. Learning more about these things from managers may make them not only more effective but happier, less lost within modern healthcare.'

In fact it is striking how discontent is concentrated among those clinicians who have had the least opportunity to work closely with managers and therefore have less understanding of their contribution. Sir Liam makes the telling point that doctors need to be educated about the roles of health service management as early as possible in their careers. A doctor replying to the survey said simply: 'You can't hate them if you get to know them.'

Research by Professor Huw Davies published in BMJ also shows that within the acute sector there is a relatively greater level of satisfaction with the relationship between managers and doctors among those at senior levels. Success will only come when those doctors and managers working in individual clinical directorates feel the same.

Managers perhaps have fewer specific lessons to learn from doctors, but individual doctors and the medical profession as a whole have always provided an inspiration to the best managers. Doctors do not enjoy such high public regard by accident. The development of a framework to support, develop and police competence is something to which managers should aspire.

There is also no doubt that doctors have many 'public sector entrepreneurs' in their ranks whose contribution to reform is priceless.

Doctors and managers must commit to reaching a better understanding and a more sustainable way of working. Not to do so would be a betrayal of the public to whom both groups owe their first allegiance.

Alastair McLellan, editor, HSJ Dr Kamran Abbasi, deputy editor, BMJ l