“Doctors can and
should be involved in the management of the NHS at all levels, for
they are the most appropriate group for the task.” - Anthony
The NHS has always
involved doctors in leadership and management. Professional
managers need the clinical help and expertise of doctors.
Psychiatry skills are pertinent: we understand the needs of the
population and we are comfortable dealing with systems and
Why do it?
- You might naturally
enjoy leadership and political environments
- You might become
dissatisfied with managers not considering doctors’ views in mental
health services and want to try to improve this situation by
- You might think the best
way to improve patients’ mental health is by looking at the whole
- You might want another
career path after becoming bored, frustrated or tired of clinical
- You might have a
specific reason - personal development, championing your own
services, or financial reward
What is medical management?
All psychiatrists are
involved with medical management. A clinical leader in a
multidisciplinary team uses management skills for the population
served by that team.
May advise managers about need
within a service but doesn’t normally have operational management
Not always medically
trained, the clinical director works in partnership with a
professional manager and is normally responsible for part of a
mental health service, including budget
Associate Medical Director
Is a deputy for the medical
director and is normally primarily involved in the professional
management of doctors, although some have operational
Executive Medical Director
- sits on the trust board and
provides professional medical advice to the board and its
- provides medical input to
strategy development and communicates the trust’s perspective to
- supports the work of clinical
directors, is often involved in clinical governance and is a
professional lead for the doctors within the trust
- has a corporate role, most
obviously in foundation trusts
Relationships with Colleagues
A management role can be personally rewarding
but can cause tension with other consultant colleagues. Consultants
value their autonomy so management arrangements with medical
directors can create difficulties.
Medical managers balance
responsibilities to patients, the profession and the organisation
where they are senior managers. This can be challenging when
managing close colleagues on performance difficulties or service
changes/development – but it is also where good medical management
Medical managers can be
criticised for switching camps but most are valued and respected
for their work. Having clinical programmed activities will
Practical steps if you’re considering a career in medical
- Talk to someone in a
medical management role and get a mentor
- Start with small roles
and work up so you gain confidence in yourself and from
- Make sure you have clear
training: the British Association of Medical Managers can help
develop skills; generic negotiating skills training can be
- Ensure that any
management role is clearly within your job plan in a way that you
could readily return to full clinical activity
- Make sure there’s a job
description that can be fulfilled within the time allowed
- Ensure you have
practical support within the trust (e.g. administration, finance,
HR) and professional support outside the trust (e.g. regional
medical managers’ meetings).
- you are a doctor and are
answerable to the General Medical Council, which has clear
expectations of the duties of medical managers
- you are a psychiatrist who needs to meet the
expectations of the Royal College of Psychiatrists
How old should I be before
considering medical management?
In general, a newly qualified consultant needs
to concentrate on their clinical work and get used to being a
consultant before taking on extra duties.
How do medical managers get
Either part of the programmed activities, i.e.
by decreasing clinical sessions to enable the work to be done or by
paying extra programmed activities or a responsibility
Will I get a clinical excellence
awards are based on quality, not quantity, of work. Extra
programmed activities for management work might not result in an
award. To be successful you must address all five domains
determined by the Advisory Committee on Clinical Excellence Awards.
A medical management role makes it easier to complete the domains
of developing medical services and managing clinical services.
However, if you’re the medical director it may be more difficult to
provide clinical services and undertake research and teaching.
What job can I do after being a
Some medical directors
find it difficult to go back to being a clinical consultant
psychiatrist. However, the medical management skills are
transferrable so there are interesting opportunities for former
medical directors – either in the same trust or national roles at
bodies including the Royal College of Psychiatrists, the Department
of Health and the Care Quality Commission.
Sources of further help and support
Medical Directors’ Forum
Royal College of Psychiatrists
Membership Relations Department
21 Prescot Street,
London E1 8BB
Tel: 020 7235 2351 ext. 289
- Young, A. E. (2003) The Medical
Manager: A Practical Guide for Clinicians (2nd edn). BMJ
- General Medical Council
(2006) Management for Doctors. GMC.
guide is intended for a consultant psychiatrist considering taking
up a management role. The information can be used as a guide only
and is not a substitute for professional advice. If you need
further advice and support, please contact the Psychiatrists’
© Royal College of Psychiatrists 2016
If you require advice and support about a particular issue then please contact the
Psychiatrists' Support Service at the Royal College of Psychiatrists on 0207 245
0412 or email
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