Re: Should the NHS abolish the purchaser-provider split?
Does the appointment of a preacher as the chairman of a bank ring a bell?
Doctors have been expected to be high level business managers in the purchaser provider scheme, the internal market scheme, budget holding schemes and more recently in the clinical commissioning process with expectations of being able to handle a large budget effectively. This is not the only time that doctors have been expected to function outside their range of expertise. In the mid to late seventies David Nicholson declared that “Within two years we want a doctor applying for every chief executive post advertised” and again “Where clinicians and managers work together, there is almost nothing you can’t achieve”.(1) But what he expects goes way beyond cooperation. It even has more the tone of a takeover.
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Let alone the intentions behind these schemes, the common fallacy in all this and in the arguments presented for yes or no surprisingly is the failure to recognise one simple fact that there is no provision to ensure that those expected to undertake financial and administrative duties should be competent and have the necessary expertise to perform these duties. Where in the routine training of a doctor is this catered for?
Members of the medical profession and the administrators should have mutual respect for each other’s abilities. Trivialising management with an ‘anything you can do I can do better’ attitude is a recipe for disaster.
As Maynard a leading expert in health economics based on his experience as chair of a provider Trust and a CCG has pointed out ‘commissioning is a complex task’ and is made even more complex by the lack of adequate information. He has however been polite enough not to question the ability of doctors to undertake this task.
Both Maynard and Dixon provide another reason why the Clinical Commissioning Groups (CGCs) was not successful. Maynard highlights the vast sums of money required to make the scheme a success and Dixon points out that ‘CGCs were born as the money ran out and their effectiveness was restricted’. Two vital requirements expertise to run the scheme and finances essential to make it a success was lacking. This did not hold back these aims. The concept of CGC and the aim to have doctors as chief executives in large numbers was aimed to satisfy ideologies.
It is the duty of the government and the NHS administrators to encourage doctors to undergo the necessary training to undertake financial and management duties. We have in recent times seen the trend of doctors following courses in finance and administration. This could be reflected in the selection of medical students. It could be an intercalated degree.
Doctors clearly have had more sense and recognising their own limitations have not set off to become chief executives. But it is a matter of concern that some involved in the commissioning process have not shown similar restraint.
(1)The rise of the doctor-manager BMJ 4 August 2007 Volume 335
Rapid Response:
Re: Should the NHS abolish the purchaser-provider split?
Does the appointment of a preacher as the chairman of a bank ring a bell?
Doctors have been expected to be high level business managers in the purchaser provider scheme, the internal market scheme, budget holding schemes and more recently in the clinical commissioning process with expectations of being able to handle a large budget effectively. This is not the only time that doctors have been expected to function outside their range of expertise. In the mid to late seventies David Nicholson declared that “Within two years we want a doctor applying for every chief executive post advertised” and again “Where clinicians and managers work together, there is almost nothing you can’t achieve”.(1) But what he expects goes way beyond cooperation. It even has more the tone of a takeover.
.
Let alone the intentions behind these schemes, the common fallacy in all this and in the arguments presented for yes or no surprisingly is the failure to recognise one simple fact that there is no provision to ensure that those expected to undertake financial and administrative duties should be competent and have the necessary expertise to perform these duties. Where in the routine training of a doctor is this catered for?
Members of the medical profession and the administrators should have mutual respect for each other’s abilities. Trivialising management with an ‘anything you can do I can do better’ attitude is a recipe for disaster.
As Maynard a leading expert in health economics based on his experience as chair of a provider Trust and a CCG has pointed out ‘commissioning is a complex task’ and is made even more complex by the lack of adequate information. He has however been polite enough not to question the ability of doctors to undertake this task.
Both Maynard and Dixon provide another reason why the Clinical Commissioning Groups (CGCs) was not successful. Maynard highlights the vast sums of money required to make the scheme a success and Dixon points out that ‘CGCs were born as the money ran out and their effectiveness was restricted’. Two vital requirements expertise to run the scheme and finances essential to make it a success was lacking. This did not hold back these aims. The concept of CGC and the aim to have doctors as chief executives in large numbers was aimed to satisfy ideologies.
It is the duty of the government and the NHS administrators to encourage doctors to undergo the necessary training to undertake financial and management duties. We have in recent times seen the trend of doctors following courses in finance and administration. This could be reflected in the selection of medical students. It could be an intercalated degree.
Doctors clearly have had more sense and recognising their own limitations have not set off to become chief executives. But it is a matter of concern that some involved in the commissioning process have not shown similar restraint.
(1)The rise of the doctor-manager BMJ 4 August 2007 Volume 335
Competing interests: No competing interests