Final Report > Chapter 25: Competent Healthcare Professionals > The systems for assuring competence > Clinicians who hold managerial positions

Clinicians who hold managerial positions

63 The events in Bristol teach us that when clinicians hold positions with formal managerial responsibilities, such responsibilities cannot properly be undertaken in the clinician's spare time. Where clinicians take on too many managerial roles in an unstructured way it is not good for patients and not good for the service which the clinicians are supposed to manage. Bristol also teaches us that management cannot properly be undertaken by clinicians who do not have the requisite skills in leadership and management. We heard during Phase Two that there continues to be a tendency to appoint the most senior consultant to the role of clinician-manager, even though seniority clearly does not necessarily guarantee managerial ability. This is not to suggest in any way that clinicians should not move into managerial roles on either a part-time or a full-time basis, nor to say that they should become disengaged from the issues of managing trusts and the NHS. On the contrary. We believe that the Griffiths Report (1983) [26] was right in advocating a much greater involvement of clinicians in management. The problem has been the implementation of this philosophy. We discovered that the situation of clinician-managers in Bristol, where they lacked time and support for their managerial roles, was commonplace at the time, and that it still persists today, despite incremental improvements to protect more time for managerial duties. We also discovered that there was nothing unusual about the practice of senior clinicians taking turns to hold managerial roles. For the future, however, where a clinician holds managerial responsibilities which go beyond immediate clinical practice, sufficient time in the form of allocated sessions must be made available and protected to enable the clinician to carry out that role. Furthermore, the clinician, before appointment to a managerial role, must have the essential skills to undertake that role, with access to training and support made available by the trust. In the hospital sector, this applies particularly but not exclusively to the role of clinical director and to other roles where the individual is expected to be part clinician and part manager. The roles of medical director and director of nursing are now, for the most part, full-time posts.

64 Not only do we endorse the views expressed in the Griffiths Report, we would go further. We believe that there should be positive incentives to encourage senior clinicians to take on senior managerial roles. These incentives should be professional as well as financial. A significant barrier to this at present is the difficulty of returning to full-time clinical practice having once become involved in management. One way in which clinicians holding senior managerial posts currently attempt to resolve this problem is by maintaining some modest involvement in clinical practice of perhaps one or two sessions per week. We see a real dilemma here. Many clinicians who hold managerial roles understandably may wish to return to full-time clinical practice, which is their vocation. Thus, they wish to maintain their clinical skills. But, from the patient's point of view this may not be satisfactory. The safety and quality of clinical practice may be compromised by the fact that the clinician's modest involvement is simply not enough to maintain the necessary clinical skills. This is not a matter on which we can be prescriptive, because safe levels of clinical practice will vary according to clinical specialty. Our aim is to point out the possible negative consequences for the patient. We believe that experts in each specialty, together with managers from the NHS, should consider this matter with a view to setting down the minimum level of regular clinical practice necessary to enable a clinician to provide care of a good quality. Clinicians not maintaining this level of practice should not be entitled to offer clinical care. This rule should also apply to all other clinicians who, for whatever reason, are not in full-time practice, and not be limited to those in part- time managerial roles. Attention should also be given to creating incentives so that clinicians who are sufficiently skilled and motivated to become managers are able to do so while retaining a prospect of returning to clinical practice. This should include incentives such as training and support whilst in the managerial role, and training and assistance to return to a clinical role subsequently, should the clinician so wish. The proposed system of revalidation for doctors, and the re-registration systems of other healthcare professionals, need to be sufficiently flexible to allow for these movements out of and back into clinical practice. Perhaps one way of enabling this would be to have special categories of professional registration which are for clinicians who are currently serving as managers, as indeed there might be categories for clinicians undertaking other types of non-clinical work.

Footnotes

[26] Griffiths R. `NHS Management Inquiry'. DHSS, 1983