Intended for healthcare professionals


Doctors and managers: What is the evidence base for management?

BMJ 2003; 326 doi: (Published 29 May 2003) Cite this as: BMJ 2003;326:1214
  1. Tim I Williams, consultant clinical psychologist (sxswiams{at}
  1. Berkshire Healthcare NHS Trust, Wokingham Hospital, Wokingham RG41 2RE

    EDITOR—I enjoyed reading the papers on doctors and managers.1 Improved mutual understanding could benefit the NHS, but underlying all the papers is an assumption that the current style of management of the health service is necessary.

    Evidence shows that centralising management of health organisations is wasteful of resources and has no beneficial impact on outcomes for patients. Bickman et al have shown in several case-control studies that centralising the management of child and adolescent mental health services results in greater costs and no improvement in child and adolescent mental health.2 If this were true for a medical intervention would we continue to offer it?

    The solution may lie in a different model of management. My experience of general practice management implies that it is possible for the clinical staff to remain in senior manager roles while the practice manager enables their work to proceed effectively and efficiently.


    • Competing interests None declared.


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