27th July 2010
Many Doctors that we’ve worked with have expressed a deep loathing of ‘management’. They are not unique in this. Legal and accountancy practices once expressed a similar distrust of the professional manager in our work with them. For these people, the technical ability to deliver good work was the key to success and the physical capability to work the punishing hours required to deliver greater volumes of work was often the route to Partnership. How can management help me when my specialist knowledge and hard work are the things that define my future?
The obvious problem for lawyers and accountants, in a Michael Porter kind of way, has been that differentiating your firm from its competitors is hard when the client only experiences your service after you’ve finished delivering it and differentiation is expensive when attracting the best in the profession means paying them more than they could earn down the road. And so it is that Strategy, Marketing, Brand, and Operations came to professional practice. Tagging along behind, as usual, is just a little bit of HR as the more enlightened realize that ‘up or out’ isn’t going to work with a generation of clever people who define personal success in ways which doesn’t mean seventy hour weeks and more cars than they have the time to drive.
Safe from the evolutionary effects of market freedom, some Doctors have retained the view of management as an unnecessary impediment to their work and it is easy to see why. GP Practices are private organisations contracting to an NHS which nannies, nags, and shouts at them ineffectually in almost equal measure. Management in the Practice is usually delegated to a senior administrator who is cheerfully overruled by the owners of the business in a Lancelot Spratt kind of way. Partners meet for a cup of coffee every now and then rather than anything that might resemble a Board meeting. After eight years of medical training who can blame any GP for not wanting to learn how to read a balance sheet, analyse their work flows for improvements or consider developing their leadership skills? The Labour Party’s reforms of GP incomes simply exacerbated the situation – salaried Doctors became more common as a (very) comfortable living could be made without the (minor) risks of Partnership and a couple of foreign holidays and a house in the country could be managed on a three day week.
Like it or loath it, Andrew Lansley’s proposed reform will put an annual £80 billion of tax payer’s money in the hands of these 36,000 highly trained technical specialists with little management experience. Mr. Lansey’s reforms will also allow patients to chose their GP by service, not location for the first time and it may be slow but the hot breath of the competition dragon might just be coming the way of the family Doctor. As the King’s Fund points out, not all GPs will be up for this and the experience of GP Fundholding from the 1990s and the slow adoption of Practice Based Commissioning in more recent times bears this out. The legal and organisational knots around implementing the reforms are enormous; the changes required for those GPs that grab the opportunity fundamental. Like Lawyers and Accountants before them, it seems that Doctors might just have to change their view of ‘management’ if they are to survive unscathed.
