Chris Lancelot on... controlling bad managers

While many primary care organisation, SHA and DoH managers are excellent, a few are not.

Unfortunately it is almost impossible for clinicians to bring bad managers to book once they are in post. At these levels managers are appointed by other managers, who can (and do) close ranks.

If GPs are proved incompetent, our licence to practise is withdrawn. Shouldn’t the same apply to managers?

Why is it that managers can bully doctors without being penalised? Why are hospital managers allowed to ‘game’ targets — for example by encouraging the admission of casualty patients and then discharging them a few hours later, simultaneously increasing the hospital’s revenue under Payment by Results and evading the four-hour target? This widespread and quasi-fraudulent behaviour wastes vast quantities of PCT money. Why are DoH managers allowed to abuse statistics — for example over the prevalence formulae?

When managers are asked to resign, they are often quietly reappointed elsewhere. Why are they not drummed out of the NHS, as GPs would be?

I have a solution: the creation of a regulatory body for NHS managers: let us call it the NHS Management Council (NMC). It would be mandatory for all NHS managers to have current NMC registration, acquired initially through demonstrating formal competence in their managerial ability.

But the real power of the NMC would be in its disciplinary functions. Any patient or health service worker would have the right to report an incompetent, bullying or unfair manager to the disciplinary body of the NMC, knowing that appropriate action would be taken. ‘Losing one’s licence to manage’ would be a threat to take seriously. The knowledge that a manager’s every action might one day have to be justified to the NMC would concentrate their minds wonderfully.

Any manager who acted incompetently, illegally or unethically would be at risk of losing their registration and thus being prevented from working within the NHS in future. Doesn’t the NHS deserve the best-quality managers as well as the best-quality doctors?

- Dr Lancelot is a GP from Lancashire. Email him at

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