Doctors and managers must improve relations

BMJ 1995; 311 doi: (Published 02 September 1995) Cite this as: BMJ 1995;311:586
  1. BMJ

    More effort must be made over the next few years to improve relationships between doctors and managers. This is one aspect of the present NHS that is not healthy, the retiring chairman of the Audit Commission says in the commission's annual report for 1994-5. Sir David Cooksey calls for the role of management to be developed in conjunction with the clinical role. In some cases, he says, doctors need to come to terms with economic and organisational reality. The two groups should come together “to agree protocols, to carry out meaningful clinical audit, to apply the results of research, and to challenge the cost effectiveness of both new and established treatments.”

    This agenda was set out in a report by the commission earlier this year (BMJ 1995;310:687).

    Although the NHS reforms offered exciting opportunities to improve the quality of the services provided in primary and secondary care, Sir David believes that they still have to bed down. He is uncertain how long the improvements will take to come to fruition in the current political climate.

    The most fundamental change was the purchaser-provider split, but the retiring chairman says that if the separation is to realise its potential a lot more has to be done to develop the purchaser role. “It is not yet clear,” he says, “that all those concerned with the assessment of needs and rationing of services have learned to do so in a way that is perceived to be fair and appropriate.”

    Sir David criticises the lack of robust data, which are needed to analyse activity to improve services. He suggests that the NHS could learn from the experience of local government by extending the use of competitive tendering to make support services, such as catering and portering, more cost effective.

    Commenting on the criticism of the relations between doctors and managers, the deputy director of the National Association of Health Authorities and Trusts, Mr Derek Day, said that “everyone in the NHS recognises that good health care requires clinicians and managers to work together in an ongoing relationship” and pointed out that a working party with the BMA, the Royal College of Nursing, the British Association of Medical Managers, and the Institute of Health Services Management aims to produce a statement of shared values to help doctors and managers to work together.

    Over the next two years the Audit Commission plans to report on the care of elderly patients with fractured neck of femur, accident and emergency services, the commissioning of cardiac services, maternity services, and NHS supplies procurement. It will also produce a report on troublesome youth jointly with local government.

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