UK: Time To Manage: Why Management Skills Should Be In Every Clinical Training Programme

Last Updated: 5 August 2015
Article by Karen Taylor

Most Read Contributor in UK, August 2017

Jeremy Hunt's recent comments on what he called a "Monday to Friday" working culture within the NHS sparked fury amongst NHS staff and set off a mass response through social media sites with doctors being singled out as needing to "get real" about seven-day working. This was the backdrop that overshadowed the release of the long-awaited Rose Report[i] whose key messages were to enable better engagement of the clinical workforce with management of the NHS. This week's guest blog is by a colleague who has spent most of her career in the NHS and explores some of the rhetoric and reality behind these events.

At my medical school interview, many years ago, I was asked why I wanted to be a doctor and despite being warned not to say something as predictable as "because I want to help people", I couldn't help it. It is the truth and it got me in. In the past few years however, the stereotype being perpetuated of doctors, is increasingly negative. Doctors aren't alone in this, with nurses also experiencing negativity whether it's through the media, which shapes public opinion, or through politicians whose comments may not always be based on robust evidence.[ii] Indeed, the censure which has traditionally focussed on NHS managers, who are either seen as taking resources from the shop-floor or expected to deliver a lot with very little, has now focussed on the front-line. Few could be blamed for concluding that now is not a good time to be working for the NHS and it is unsurprising that there is disharmony amongst the NHS workforce. As the recently released Rose review highlights, "There is a widespread and deep-rooted perception that management is the "dark side". Doctors and nurses can be seen and often position themselves in opposition to management. This is unhelpful". 

While I know first-hand these stereotypes to be untrue, I nevertheless saw how these constant external messages filtered through to the everyday working environment and how it affected the morale and behaviour of an already burnt out workforce.[iii] There were times when I could see that the people I worked with found it easier to revert to stereotypes, especially when it came to things they didn't understand but considering the increasing workloads with diminishing resources, there was hardly time to make effort to understand. I could clearly see why top-down and bottom-up visions didn't always align. Since I left the NHS, I have had the time to stop, think and make the effort to learn; a luxury that I never had as a doctor. It isn't that clinicians don't want to be helpful, it is more that they don't have the tools, especially the language, skills, training or experience in managing change within organisations; time is not given for development in these areas. 

Nevertheless, a good example of the gap between rhetoric and reality is the controversy over seven-day working. Elements of seven-day working has always existed in some parts of the NHS such as acute hospitals. However, in 2013 it was announced that seven-day working will become more widespread in the NHS. There was an "overwhelming response" from across health and social care to take up the changes with support from NHS England for the early adopters.[iv] While many NHS organisations are making progress, wide adoption remains patchy with doctors being blamed for this. Whilst there is no evidence to support the claim, it is also detrimental to progress.

The reality is that the challenges are multifactorial and the major problem is that there simply hasn't been, nor is there likely to be, the funding to support the provision of seven-day working, a fact validated by the Nuffield Trust's press statement shortly after Jeremy Hunt's recent announcements. The Nuffield Trust also stated that in order to deliver these ambitions, there are likely to be some very tough management decisions and every effort needs to be made to include clinical staff in the decision making.[v]

Many clinicians understand why they should be more involved with management, yet there is still a culture that says "I just want to get on and do my job". The realisation that taking time for management is in fact part of the job, has yet to be an established norm.

I was at a medical conference late last year and was talking to the medical director of a large foundation trust. I asked him whether clinicians at his Trust were involved in management. In response, he praised his current cohort of junior doctors for producing fantastic clinical audits and helping to set up service improvements which had achieved impressive results. I asked him what support they had, was time integrated into their rota and what were his plans to extend this more widely across the organisation? He answered "well they just did it...I was never given any time as a registrar. They're doing it in their spare time." 

An effective NHS workforce is key to the future sustainability of healthcare and to be effective all aspects need to be valued including management skills.[vi] In the words of Sir Stuart Rose, "the NHS performs an extraordinary service and is staffed by some extraordinary people, but the whole organisation could and should be made more effective by the application of some common-sense tactical and strategic thinking". [vii]


[i] Better leadership for tomorrow: NHS leadership review. Rose Review. 16 July 2015. See also: http:/
[ii] The Telegraph (Corrected Article) Michael Gove left on crutches because he couldn't get an x-ray over weekend. 22 Jul 2015. (accessed 25th July 2015)
[iii] Wilkinson E. UK NHS Staff: stressed, exhausted, burnt out. The Lancet. March 2015; Vol 385, Issue 9971, p 841-842.
[iv] First Cohort of Early Adopters – 7 days services announced, November 18 2013. See also:
[v] Nuffield Trust. Responding to new announcements by Jeremy Hunt on seven-day working and transparency. 16th July 2015. See also:
[vi] West MA et. al. NHS Staff Management and Health Service Quality : Results from the NHS Staff Survey and related data. 2011. See also: 22nd July 2015)
[vii] Better Leadership for tomorrow: NHS leadership review. 16th July 2015. (accessed 22nd July 2015)

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