Intended for healthcare professionals

Head To Head Healthcare Regulation

Should NHS managers be regulated like doctors?

BMJ 2021; 372 doi: (Published 23 February 2021) Cite this as: BMJ 2021;372:m4909
  1. Jenny Vaughan, law and policy lead1,
  2. Marcel Levi, chief executive2
  1. 1Doctors’ Association, London
  2. 2University College London Hospitals, London
  1. Correspondence to: J Vaughan jenny.vaughan{at}, M Levi marcel.levi{at}

In recent NHS scandals, why have managers escaped long term consequences, unlike doctors and nurses? Jenny Vaughan believes that managers should be put under a regulative system similar to doctors. But Marcel Levi argues that the last thing we need is more regulation when other tools are available

Yes—Jenny Vaughan

What healthcare needs is a level playing field for all of its workers, with a fair system of regulation that acknowledges that a “rogue” manager is just as damaging as a “rogue” clinician.

In the 2013 report into failings at the Mid-Staffordshire NHS Foundation Trust, Robert Francis concluded that managers on the trust board were “weak” and “too focused on reaching targets, achieving financial balance and seeking foundation trust status at the cost of delivering acceptable standards of care.”1 He criticised managers at the local and regional level for failing to respond to complaints and for being “uncritical.”

Unlike doctors and nurses, however, NHS managers are not subject to professional regulation. Francis stopped short of calling for such regulation but recommended that NHS directors must meet the fit and proper person test (FPPT), including an assessment of senior managers’ qualifications, competence, skills, and experience that are considered necessary for the relevant position.2

The fit and proper person regulation (FPPR) requirements came into force for all NHS trusts and foundation trusts in November 2014.3 These regulations require NHS trusts to seek the necessary assurance that all executive and non-executive directors (or those in equivalent roles) are suitable and fit to undertake the responsibilities of their role.

Subsequent experience and the Kark review4 have shown, however, that the FPPT, at least as currently formulated, is not a satisfactory substitute for a register supported by a regulatory system.5 Any such measure could first be restricted to directors—executive and non-executive or …

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