BMJ 1995;310:244-246 (28 January)

Education and debate

Management for Doctors: Making finance work for you--strategic issues in clinical directorates

John Stuart, professor emeritus,a Peter C Spurgeon, professor,b Anthony Cook, lecturer b

a Department of Haematology, Medical School, University of Birmingham, Birmingham B15 2TT, b Health Services Management Centre, University of Birmingham, Birmingham B15 2RT

Correspondence to: Professor Stuart, 12 Brueton Ave, Solihull B91 3EN.

The NHS has a long history of underinvestment interspersed with periodic bouts of overspending to relieve the ensuing crises. Strict cash limits make it unlikely that funding will match the multiple demands of an increasingly aging population, rising drug prices, and advancing technology. In this context it is difficult to perceive the finance function as a "flexible friend."

The restructuring of the NHS, with the formation of budget holding clinical teams (directorates) and self governing (trust) status for hospitals, and especially contracting, which brings together activity and financial data, means that clinicians now have the opportunity to influence the use of revenue funds in a more imaginative way than before, to improve patient care. Yet, many doctors view financial management as yet another mechanism for restricting clinical freedom. But doctors who participate actively in financial management within a sufficiently . . . [Full text of this article]


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