Final Report > Chapter 5: Management in Bristol > The system of clinical directorates

The system of clinical directorates

9 In 1989 the system of clinical directorates was in the process of being introduced across the District. [9] Central to this system was the concept of semi-autonomous units, based on a medical specialty or group of specialties, whereby full budgetary responsibility and clinical decision-making could be combined in a single entity. Thirteen clinical directorates were established, each managed by a clinical director (a consultant) and a general manager, and each formulating its own business plans. The larger directorates were split into associate directorates, managed by associate clinical directors and associate general managers.

10 Clinical directors were responsible for formulating policy. They led their particular service and held budgets. General managers were responsible for implementing policy within each directorate. The system which evolved during 1990-1995 was for the clinical directors to report to the DGM (the chief executive after the adoption of Trust status) and for the general manager to report to the clinical director and to the director of operations.

11 These changes led to an alteration in the managerial role of the medical staff. From 1985 onwards, medical staff had been involved in the management of services through the system of clinical divisions. From 1990 medical staff who became clinical directors or associate clinical directors had a greater degree of managerial autonomy and authority and were able to negotiate changes in services through planning or contracting. General managers working alongside clinical directors and associate clinical directors had a supportive role. [10]

Footnotes

[9] WIT 0108 0006 Dr Roylance

[10] WIT 0074 0011 Dr Baker