NHS pressures undermining relations between doctors and managers, study shows

Our new report looks at the relationship between hospital managers and senior doctors.

Press Release

Published: 01/12/2016

A new survey of hospital managers and senior doctors finds signs that they are working together better than in the past, but warns relations have been damaged by reorganisation and financial pressures.

The poll of 472 leaders and clinicians in management roles is published today in the Nuffield Trust report Managing doctors, doctors managing, along with results from interviews, a focus group and a review of academic literature. It finds that 60% now believe local doctor-manager relationships are positive, up from 47% in a 2002 study, and respondents are now more confident that managers put patient care first. However, a higher proportion of respondents (37%) now believe relations are likely to deteriorate over the coming year, compared to only 13% in 2002. 

Good working relationships between managers and doctors mean that their complementary knowledge, skills and experience can be harnessed to address these challenges. But a key finding from our study was that successive and often conflicting government policies have undermined the stability of these relationships.

Huw Davies, Professor of Healthcare Policy and Management, University of St. Andrews

Factors identified as pushing doctors and managers apart included pressures from the financial squeeze and new regulatory drives, as well as the 2012 Health and Social Care Act. 88% of respondents agreed that the system for managing and regulating hospitals was poorly co-ordinated and punitive, while 87% saw rising tension between cost control and improving the standards of care. Authors Huw Davies and Alison Powell conclude that the lack of relief from reorganisation and financial pressure risks worsening relationships at a time when jointly led change is urgently needed.

The survey also shows a divide in how doctors and managers see the world. At the top of the management structure, chief executives saw the most positive picture while clinical directors, the NHS’s frontline medical leaders, were the least positive. While 80% of chief executives believed that relations were likely to improve in the next year, only 35% of clinical directors thought the same. Two thirds of respondents believed managers exerted pressure to discharge patients early, including most directorate level managers – but a majority of chief executives disagreed. Across all roles, half of respondents believed doctors viewed managers’ decision-making process as unfair.

The study also looks at initiatives to improve how doctors and managers work together. It finds that while collaboration on individual projects was widespread, learning, training and opportunities for the two groups to meet informally were patchy. Again, chief executives were more likely to believe these initiatives existed in their hospital than managers and medical leaders nearer the front line.

Report author Huw Davies said:

“The NHS faces a complicated, difficult task in delivering high quality, safe and compassionate care under rapidly changing demands, significant financial constraints and relentless media and political scrutiny. 

“Good working relationships between managers and doctors mean that their complementary knowledge, skills and experience can be harnessed to address these challenges. But a key finding from our study was that successive and often conflicting government policies have undermined the stability of these relationships.

“When the link between doctors and managers fractures, it makes providing good care within the available resources much harder.  NHS managers – both medical and non-medical – need to be valued by government, given enough resources, and provided with a stable context in order for them and the hospitals they manage to flourish.”

Notes to editors

  • For more information contact Mark Dayan at 0207 462 0538 or Leonora Merry at 0207 462 0526.
  • Survey questions were sent to 3467 NHS chief executives, medical directors, clinical directors and directorate managers, online and by post between May and October 2015. 472 responded, comprising 59 chief executives, 131 medical directors, 132 directorate managers and 150 clinical directors.
  • While the junior doctors’ contract dispute began during this period, our survey focused on more senior doctors in management roles and their views on relationships with managers locally.
  • The survey repeated some questions from a 2002 survey by Huw Davies and his colleagues, which was published in the BMJ, along with new questions to gauge the impact of recent events.