The transition from professional to manager can be uncomfortable and difficult. It requirers a different set of skills, it's not just the responsibility for budgets although this can result in a conflict between professional values and rationing services or imposing eligibility criteria it's the emphasis on people management skills. Being a gifted teacher doesn't mean someone would make a competent head teacher. Clinicians go through a long period of medical apprenticeship where they live in a command and control environment and then they become a consultant and now they are independent . Make them a medical manager and the easiest thing for them to do is to revert to the trainee mode and start telling others consultants what to do and in an integrated health and social care world try and tell partners from social care what to do.
Perhaps the answer would be joint health and social care senior management leadership training but the cultural problems should not  be underestimated.
Blair McPherson former director of community services