The natural managers?: a study of the evolving role of NHS doctors in management

Abstract

This study traces the evolving role of NHS doctors in management, from the early years of informal, but highly influential involvement, to the formalised and accountable positions they now occupy in management. The study attempts to assess whether doctors are "the natural managers" of the NHS and, if so, the implications of this. The associated argument, which is pursued throughout the study, is that power and authority need to be brought together in order for management to be effective and argues that the involvement of doctors in management is the only realistic way to bring this about. A qualitative research approach has been used to explore through interviews, the views, opinions and experiences of 30 key informants, including Consultant Medical staff, (many of whom occupy Medical/Clinical Director positions). General Medical Practitioners, Chief Executives, senior NHS Executive and Health Authority officials, and other health professionals. The study, which is mainly centred on the operational level in secondary care, concludes that the active, formal involvement of doctors in management does bring about the blend of power and authority which was previously missing, but no over-riding view was expressed by informants to suggest that this means doctors are "the natural managers." In order to make better use of clinical and other resources, a shared partnership in decision making at the top of the management structure between the senior doctor manager and the lay Chief Executive is required. More encouragement is needed to develop the present fragile role of doctors in management in order to secure the relatively untapped source of managerial power and authority which the involvement of doctors in management can bring about.