LEADERSHIP AND MANAGEMENT
Professor Hugo Mascie-Taylor, medical director of the NHS Confederation, says new clinical managers are going to have to deal with extra responsibilities.
I
t is becoming clear that managers at all levels of secondary care will have to find
ways to make both their staff and them- selves more productive to help mitigate the changes occurring in primary care.
Part of that change involves putting doc- tors in charge of commissioning - so what about putting more clinicians in charge of managing secondary care?
It seems that whilst many doctors are keen to become more involved in the process there are, as always, wide differences in how the shift is occurring across the NHS.
Hugo Mascie-Taylor, medical director at the NHS Confederation, told NHE: “Clinicians are usually arranged in some form of hierarchy, the head of which in secondary care is the medical director.
“The role of medical director encompasses the whole medical agenda of their organi- sation, which is about to increase sub- stantially as, in all probability, the medi- cal director will also take on the role of ‘responsible officer’ which will include the gathering of quality data and running ap- praisal systems.
“This is one clear area of responsibil- ity which is about to increase; the second clear area of responsibility is in regard to doctors in difficulty or going through disciplinarily issues. A framework agree- ment signed in the last few years makes it very clear that these matters fall under the medical director and the HR director.
“But while typically the responsibility for quality and the responsibility for safety are core to the role, there is then a variation in what medical managers do.”
This has led to different medical directors taking on different levels of responsibility, Mascie-Taylor explained.
He said: “The minimum amount of re- sponsibility would include taking various aspects of the medical agenda with regard to revalidation and disciplinary issues. The maximum amount of responsibility a medical director would deal with would be something more like the Keizer model, which is used in the United States, where the doctors effectively run the organisa- tion - they are the managers of it.
“But in the NHS there is no particular pat- tern to how secondary care trusts use doc- tors in management or, looking at it from the other perspective, there is no pattern in terms of how much doctors want to be involved in management.”
So should the NHS be taking a more con- sistent approach towards doctors in man- agement in secondary care?
“I’m not sure that consistency itself is necessarily useful,” Mascie-Taylor states. “Personally, I would start by coming up with a consistent model; I would ask what is the most appropriate use of doctors in management and how do we get them into that situation?
“It seems to me that the reality is that doc- tors enjoy significant power.”
For Mascie-Taylor the reforms currently winding their way through Parliament could be seen as “an attempt to align power and accountability”, but he added: “There is doubt that what follows doctors’ decision making is allocation of resource – both in primary and in secondary care.
“You could take the view that organisa-
tions will work more effectively more of- ten when power and accountability are aligned than when they are not. So how do we align power and accountability for doc- tors? The answer is to either reduce their power or give them more accountability if we assume that there is a mismatch.
“Can we reduce their power? Well, tradi- tionally this has proved difficult to do. Can you increase their accountability?
“Yes, if you develop a management model where they explicitly have the accountabil- ity, where that accountability is enforced and where the doctors are prepared to do that.”
Whatever roles and responsibilities will be undertaken in future remains to be seen, but what is ab- solutely clear is that the Government’s reforms will signal major changes to the way doctors provide their services to the public.
Hugo Mascie-Taylor
FOR MORE INFORMATION Visit
www.nhsconfed.org
national health executive Mar/Apr 11 | 35
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