Breaking the circle

Problems persist in doctors’ relationship with management in the NHS. An analysis by the King’s Fund has found a “consistent discrepancy” between the views of the NHS held by executive directors on NHS boards and the views held by doctors and other clinicians. Most executive directors feel positive about their organisations’ working culture and think that their organisations are characterised by “openness, honesty, and challenge.” In contrast, only a quarter of doctors feel positive about their organisations’ working culture, and fewer than half think it is open and honest.

On top of this, Monitor and the NHS Trust Development Authority found that doctors taking on management roles are often new to the job and lack the support and clear career pathways they need to develop (http://careers.bmj.com/careers/advice/view-article.html?id=20017782). A survey by the two organisations identified the need for a “clearer career option within the NHS” to attract doctors into “increasingly crucial” management posts.

A clear argument could be made that these problems have emerged from a circle of interdependence. Part of the reason that the UK needs to attract more doctors to management posts is because doctors do not see management as a clear and obvious part of their career progression. Underlying that, part of the reason why doctors do not see management as a natural step in their career path may be tied to their view of the working culture of NHS organisations. At the root of the problems with working culture are weaknesses in management and leadership, and part of the solution to improving management and leadership in the NHS will involve encouraging more doctors to take up such posts.

The solutions to these problems proposed by the King’s Fund, Monitor, and the NHS Trust Development Authority are worth pursuing. They may well help to solve the specific problems identified. Ultimately, they may help break this problematic circle.