Intended for healthcare professionals

Rapid response to:

Editorials Christmas 2012: Editorial

When managers rule

BMJ 2012; 345 doi: (Published 19 December 2012) Cite this as: BMJ 2012;345:e8239

Rapid Response:

Re: When managers rule

I congratulate Sir Brian Jarman on an excellent and timely editorial (1). Sadly, in parts of the NHS patient care is sometimes seen as secondary to managerial imperatives. If a clinician is performing to high standards in terms of clinical excellence and professional conduct, yet gets on the wrong side of a manager or a medical director, whether it be for whistleblowing or other reasons, he/she may well suffer serious consequences as a result (2). This clearly needs to change.

Managers and medical directors require better training and regulation, and they need to be held more accountable for their actions. Any disciplinary process brought by managers or medical directors must respect the three key principles of independence, expertise and plurality. The Department of Health document, Maintaining High Professional Standards (3), is now over 8 years old and needs to be significantly updated, since it is open to manipulation and abuse. Any revised guidelines should apply to all NHS staff, and not just to doctors, dentists and pharmacists. There also need to be changes in legal and General Medical Council (GMC) settings. It is in the interests of employment tribunals and GMC panels to respect the three principles of fairness outlined above. NHS staff should not be at a disadvantage in legal or related settings simply because they cannot afford as expensive (and often as aggressive) legal teams as those employed by NHS Trusts.

GMC and legal panels need to be trained and forewarned about the cognitive psychology of legal reasoning, its fallibility and its biases, as is now a requirement in some legal settings in the USA (4). Doctors and others who undergo work-related stress, which must include stressful GMC or employment tribunal hearings, are more likely to suffer ill-health and to become suicidal (5, 6). Hopefully, the forthcoming Francis Report on the mid-Staffordshire scandal will send a wake-up call to the Department of Health, and the Department will see the need for radical changes at various levels in the NHS (7). The current status quo results in suffering to NHS staff, to wastage of public funds on legal expenses and costly settlements, and to poor patient care.

(1) Jarman B. When managers rule. BMJ 2012; 345: e8239
(3) Department of Health. Maintaining High Professional Standards. London, 2006.
(4) Lilienfeld S, Byron R. Your brain on trial. Scientific American Mind 2013; 23: 44-53.
(6) Hawton K, Malmberg A, Simkin S. Suicide in doctors. A psychological autopsy study. Journal of Psychosomatic Research 2004; 57: 1-4.

Competing interests: No competing interests

06 January 2013
Narinder Kapur
University College London
1-19 Torrington Place, London, WC1E 7HJ