Intended for healthcare professionals

Feature NHS Leadership

Why would a consultant think of going into management?

BMJ 2015; 350 doi: (Published 24 February 2015) Cite this as: BMJ 2015;350:h922
  1. Richard Vize, freelance journalist, London
  1. richard.vize{at}

The NHS is keen to encourage more senior doctors to move into management, but few make the leap. Not only is there an “us and them” culture but the risks are far too high. Richard Vize reports

The job of NHS trust chief executive almost seems like it was designed to dissuade doctors from applying. It requires a consultant to ditch their job security, probably earn less money, be saddled with problems they don’t have the power to solve, and risk public humiliation and professional ruin.

As Hugo Mascie-Taylor, medical director at NHS regulator Monitor and former special administrator at Mid Staffordshire Foundation Trust, puts it, “I’m not saying you have to change the nature of the role, but we have to recognise that as it stands it does not attract doctors.”

Russian roulette

The fate of Mark Newbold exemplifies the risks that doctors take if they enter senior management. In November he was left with little choice but to resign as chief executive of Heart of England NHS Foundation Trust after Monitor had raised the prospect of forcing a change of leadership over waiting times and concerns over mortality rates.1

Before entering management Newbold spent 20 years as a consultant in gastrointestinal disease and histopathology. His departure raised the question of why any doctor would choose to surrender their clinical career for the Russian roulette of NHS management, where the average survival time of a trust chief executive hovers around 700 days (box 1).

Box 1: Mark Newbold on NHS management

Doctors are selected on the basis of their motivation to provide direct patient care, so it will always be a minority that chooses to follow a managerial career. But for those who do, the job of chief executive is a hugely rewarding one to which they can certainly bring highly relevant insight and experience.

Hospital chief …

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