It's time to ignore the prima donnas in the NHS

Recently I asked who should be in ultimate charge of the NHS, and concluded that it works far more effectively as a symbiotic relationship than a master-servant one.

The NHS will be the better for being run by a combination of politicians, managers, and professionals, provided each of these groups is prepared to defer to others in those areas where they have no expertise.

This multi-disciplinary approach already works well within the NHS. Life becomes difficult when acknowledged experts in a specialised field fail to recognise their boundaries and won't give way in other areas where their knowledge is merely average. Good multi-disciplinary working is threatened when prima donnas are present.

The prima donna syndrome can apply to doctors, nurses, managers and politicians alike: it's all about the individual, not the job. It is also quite understandable. A competent surgeon will be used to having his own way in his own specialty: being humble enough to accept the advice of others may come as something of a challenge. Exactly the same holds true for nurses and accountants.

Recognising that other people may have a better insight is one of the hallmarks of maturity and professionalism. Doctors can experience problems here. We often feel that being well educated, skilled and dedicated should by itself give us the right to be dogmatic in other areas: it doesn't follow.

This is particularly true in healthcare management. Doctors can have difficulty in accepting the input, advice or instruction of managers. Yet most of us do not have managerial skills. Many doctors are surprised to discover that managing a supermarket chain is not that different from managing the health service, once they recognise that the job of the manager is merely to bring the customer and the supplier together most efficiently. Obviously, in the NHS the bottom line isn't profit: but managers are still tightly constrained fiscally by their political masters.

True, there are idiots in management, just as there are poor quality surgeons and hopeless politicians. But the way forward for the NHS is to harness the specialist abilities of each group, and above all to limit the powers of those advising outside their areas of expertise. Lord Darzi, take note.

Dr Lancelot is a GP from Lancashire. Email him at

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