Good working relationships between doctors and managers are critical for the safety and quality of NHS care. Yet recent reports have referred to a ‘gulf’ between the two groups and to the growing risk of clinicians disengaging from management. This research uses a detailed survey of doctors and managers at board and middle-management levels of NHS acute trusts – along with interviews and a focus group – to understand their views on the current state of the doctor–manager relationship in the UK, the pressures it is coming under, how it has changed, and the outlook for the future.
In 2002 the same authors undertook a similar survey. That survey found that doctors and managers disagreed around key issues, including: the influence and involvement of doctors in hospital management; the quality of managerial staff; and the balance between financial and clinical priorities. There have been significant changes in the political landscape since the 2002 survey was carried out, such as: the Darzi report, the change of UK government in 2010 and 2015, the publication of the Francis reports in 2010 and 2013 and the increasing financial pressures on the NHS. As such, it is important to revisit the issues explored in the earlier survey to look at how perceptions of working relationships between doctors and managers at board and middle-management level have changed over time.
Similar to the initial findings, the 2015 survey found that managers and senior doctors in management see things differently. At the top of the management structure, chief executives were the most positive overall on a wide range of issues. Clinical directors, the NHS’s frontline medical leaders, were least positive.
Compared to the previous survey, there has been some improvement in overall positive scores of local doctor–manager relationships. But a growing proportion of respondents believe that these relationships are likely to deteriorate over the coming year.
To continue to improve the relationship between these two groups, a degree of organisational stability and a sustained period of appropriate resourcing are needed. Streamlining the regulatory and performance management arrangements to ensure better coordination and a genuine emphasis on learning and data to support improvement is desirable. A particular focus on clinical directors may also be needed, for example by creating a national framework to reduce the variability and in providing a focus for the spread of successful initiatives more widely.