Clinician Versus Manager: Overcoming the Great Divide

The NHS needs to change for it to meet the rising demands. Delivering on both the five-year forward view and the STPs will be one of the biggest challenges NHS leaders will face in the coming year. I sat down with Smriti Singh, Programme Director and husband Neil who is a clinician to discuss how they have drawn on each other’s experiences and insights to benefit them both.

doctor working on laptop

When I tell people that I work with senior NHS management and that my husband is a surgeon, I am frequently asked “is that a problem?”

The underlying assumption is that managers and doctors don’t get on. For us, the reality couldn’t be more different. Not only have our professional lives not damaged our relationship, we have both found that having a partner on the other side of the great management/ clinical divide is hugely beneficial.

Neil and I met over 20 years ago, when he was a newly-qualified doctor and I was an analyst with PA Consulting. Our professional worlds only came together in recent years, after I set up my own niche consulting firm.

By the time Neil became a consultant surgeon in 2012, I’d started working with NHS commissioning organisations and providers, running large change programmes and eventually taking on a role as programme director across an STP. In 2016, Neil was appointed a divisional director for surgery involved with strategic issues in the trust and the local health economy.

Our day-to-day work is quite different. On the surface, Neil’s work is operational, immediate and necessary. Mine is strategic, high level and abstract. There is a lot of potential for mutual misunderstanding.

But we’ve learned something very important. We are facing the same systemic challenge. Both of us are working to modernise the healthcare system, to move from one that just ‘fixes’ people to one that helps us all to live well.Some of the things I’ve learned from Neil…

The mammoth, unrelenting challenge of running an NHS provider

Despite all the talk amongst policy people of integrated care systems, NHS trusts still need to be viable entities – they need to deliver a high-quality service, remain financially viable and meet regulatory demands. This means that people like me need to develop transformation programmes that work that recognise this, and not just a vision which seems a world away from acute trusts’ daily existence.

Increasing complexity of modern medicine

In my world of policy people and commissioners, all the talk is about a multi-skilled workforce, working flexibly and blurring professional boundaries, to bring about efficiencies. The reality is that, for acute care, increasing specialisation has meant better outcomes. Talking to Neil has made me see that commissioners need to recognise this reality and moderate some of the very broad-brush messaging around implementing integrated systems.

Engaging clinicians

There is a view amongst senior healthcare managers that clinicians only listen to other clinicians. This thinking often leads to people being appointed to senior roles due to their clinical qualification, rather than their management skills. Talking to Neil, I’ve realised that, whilst some doctors and nurses are tribal, most are not many feel disengaged from national policy and local programme plans. Failure in engagement is frequently due to failure to make a sound case for a particular change; rather than who is making it. Some things Neil has learned from me…

We are on the same side, striving for the same outcomes

There is a widely held view that doctors put individual patients first, whereas managers’ prime concern is money. Neil now feels that both camps care about delivering a great service, but that this can only be achieved by taking a whole population view. Systems need to be designed around the disease population, rather than trying to fix the system one patient at a time.

Understanding the wider healthcare system

Acute medical teams view hospitals as central to healthcare delivery (understandable as acute trusts have the highest concentration of patients). Neil has come to understand that acute trusts are in fact a cog, albeit a large cog, in the overall system. Moreover, if healthcare is to be made sustainable then more patients must avoid theacute trusts and costs involved where possible. This can only be achieved by working with the rest of the healthcare systems. So, as a clinician, he must understand that system.

New concepts in national policy

I’ve undertaken a lot of work in the personalisation and firmly believe it can bring about transformative change. Neil adopted it in his department and in his surgical practice, setting up a multi-disciplinary shared-decision making process. It involves the patient as an equal partner, alongside their surgeon and anaesthetist. He has changed the way he runs clinics, so that for the first two minutes of every consultation, he just lets the patient speak. The results are remarkable and have his changed clinical decisions.Ultimately, Neil and I have both learned massively from each other and continue to do so every day. We have learned because we both accept that the health and care system is huge, complex and needs many people and different skills and roles to make it work. Our successful working partnership is a result of the same mutual respect that makes for a successful marriage.

Final thoughts 

So, what do you think? Both as a clinician and a manager in the NHS? Does NHS management work closely enough with clinicians? Is there a Divide? Can more be learnt working closer with management and clinicians? Could you work with your partner?

Sean Nicholson specialises in the Healthcare market and manages assignments across all disciplines within the Healthcare sector in the North region.


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