Chris Lancelot on... Doctors as NHS managers

Modernising Medical Careers (MMC) is one of the most inept projects ever inflicted on the NHS. Worse, from the start, its architects were consistently warned about it. It is not as if they made an unfortunate mistake which they are now regretting: they were told, they were warned, they were cautioned - and all to no avail. MMC has now dislocated the careers of 10,000 junior doctors, wasted billions in medical education costs, and dumbed down consultant training.

Professor Alan Crockard, the head of MMC, eventually resigned after being reported to the GMC. I would go much further: I think every doctor involved in management of the scheme should be held personally responsible for their decisions.

I am not a vindictive person: we all make unintentional mistakes. But MMC was different: its inception appeared to have involved deliberate, arrogant persistence in the face of continued, reasoned opposition from all parts of the profession.

Make no mistake, NHS management decisions are potentially dangerous for both patients and staff. We would never introduce a new drug without extensive pilot studies.

As with a new medical treatment, doctors involved in management have a duty to advance carefully and carry out appropriate pilot studies before implementing any management technique.

The NHS needs a sea-change in its attitude towards management. Managers must be held personally responsible. Nor should they be allowed to hide behind corporate responsibility.

We can begin with doctors in managerial posts. If any management project goes wrong the clinicians leading it should routinely risk being charged with professional negligence. There should be only four defences - that they were doing what a sizeable proportion of their colleagues would have done under the circumstances; that it had been forced upon them by more senior managers or politicians; that pilot studies had either been run successfully or were impossible to carry out; or that they had voted against implementing the project in its existing form.

Samuel Johnson observed that the prospect of being hanged on the morrow concentrates the mind wonderfully. Being hauled in front of the GMC - or at least the thought of it - should similarly concentrate the minds of doctors in management.

Dr Lancelot is a GP from Lancashire. Email him at

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