Medical Management

305 Pages·2012·1.93 MB·English

by  Markar, Hameen, O'Sullivan, Geraldine

MEDICAL
MANAGEMENT
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MEDICAL
MANAGEMENT
A PRACTICAL GUIDE
Edited by
Hameen Markar MBBS (Sri Lanka) FRCP (Edin) FRCPsych
MPhil (Edin)
Retired Medical Director, Bedfordshire & Luton Mental Health NHS Trust and
South Essex Partnership Foundation Trust (Bedford & Luton); formerly Associate
Lecturer, Department of Psychiatry, University of Cambridge
Geraldine O’Sullivan MB BCh BAO (National University Ireland)
MD (NUI), FRCPsych, Diploma Company Direction (IoD)
Executive Director – Quality and Medical Leadership, Hertfordshire Partnership
NHS Foundation Trust
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S
Contributors vii
T
N
Preface ix
E
Part 1 Management in the NHS – general issues
T
N Healthcare management – an overview 3
1
O
Peter Graves
C
Quality and safety 18
2
Elizabeth J Haxby
Leadership styles and skills 34
3
James Matheson and Jacky Hayden
Information technology, innovation and healthcare 50
4
Hameen Markar and Nadeem Mazi-Kotwal
Healthcare commissioning and contracting 61
5
John Hague and Matt Fossey
Measuring healthcare outcomes 72
6
Julian Flowers and Raja Badrakalimuthu
Change and project management 89
7
Hameen Markar
Evidence-based healthcare and medical management 100
8
Mark Agius and Anton Grech
Part 2 Medical management – specific issues
The role of the board and its directors, including the
9
executive medical director 117
Geraldine O’Sullivan
The doctor as chief executive 131
10
Philip Sugarman
Roles and challenges of a clinical director 141
11
Sajeeva Jayalath
Financial issues for doctors 154
12
Trish Donovan and Peter Graves
Developing personal effectiveness: what does it take to
13
become a good doctor? 170
Hameen Markar
CONTENTS
Doctors in difficulty 184
14
Peter Old and Alastair Scotland
Medical education and training 199
15
Simon Gregory
Appraisals and revalidation 217
16
J Thiagarajan
Public health 227
17
Paul Cosford
Medical management in mental health services 237
18
Sylvia Tang and Geraldine O’Sullivan
Medical management in acute care 247
19
Ed Neale
Medical management in private healthcare 262
20
Duncan Empey and Sheila Peskett
Medical management in primary care 275
21
Paresh Dawda
vi
Contributors
Mark Agius MD
Visiting Research Associate, Department of Psychiatry, University of Cambridge; Associate
Specialist, South Essex Partnership, University Foundation Trust; Research Associate, Clare
College, University of Cambridge, UK
Raja Badrakalimuthu MBBS, MRCPsych
ST 4 Psychiatry, Cambridge and Peterborough Mental Health Trust
Paul Cosford BSc(Hons) MSc MBBS(Hons) MRCPsych FFPH
Director of Health Protection Services at the Health Protection Agency; Honorary Senior Fellow in
Public Health at the University of Cambridge
Paresh Dawda MBBS DRCOG DFRSH FRCGP FRACGP
Medical Director ACT GP Super Clinic, Ochre Health; previously GP Principal – South Street
Surgery and Teaching Faculty – NHS Institute for Innovation and Improvement
Trish Donovan ACMA CGMA
Director of Finance, North Staffordshire Combined Healthcare NHS Trust, Stoke-on-Trent
Duncan Empey FRCP
Group Medical Director, BMI Healthcare, Brentford, Middlesex
Julian Flowers MRCP FFPHM
Consultant in Public Health Medicine; Director, Eastern Region Public Health Observatory &
Quality Intelligence East
Matt Fossey BSc MSocSc DipSW DipMHStud FInstMH
Senior Associate, Centre for Mental Health, London; Honorary Lecturer, University of Nottingham;
Independent Healthcare Consultant
Peter Graves MBBS FRCGP
Chief Executive of Bedfordshire & Hertfordshire LMC Ltd and GP
Simon Gregory BSc MBBS DRCOG DFRHC DCH M Med Ed FHEA FRCGP LoC SDi
Postgraduate Dean, East of England, Cambridge; Visiting Professor, Norwich Medical School,
University of East Anglia and Anglia Ruskin University
Anton Grech MD MSc MRCPsych
Chairman and Consultant Psychiatrist Psychiatric Service Malta; Lecturer in Psychiatry,
University of Malta
John Hague MBBS DRCOG
Partner, The Derby Road Practice, 52 Derby Road, Ipswich; Board member Ipswich and East
Suffolk CCG
Elizabeth J Haxby MBBS MA MSc FRCA
Lead Clinician in Clinical Risk, Royal Brompton Hospital, Royal Brompton and Harefield NHS
Foundation Trust
Jacky Hayden FRCP FRCGP FAcadMed
Dean of Postgraduate Medical Studies North Western Deanery and Manchester University
CONTrIbuTOrS
Sajeeva Jayalath MB BS(Hons) MRCPsych
Consultant Psychiatrist and Clinical Director, SEPT providing services for Luton, Bedfordshire and
Essex
Hameen Markar MBBS (Sri Lanka) FRCP (Edin) FRCPsych MPhil (Edin)
Retired Medical Director, Bedfordshire & Luton Mental Health NHS Trust and South Essex
Partnership Foundation Trust (Bedford & Luton); formerly Associate Lecturer, Department of
Psychiatry, University of Cambridge
James IDM Matheson BA(Hons) MBBS DMCC
Academic Foundation Doctor, Academic Foundation Programme, Royal Lancaster Infirmary;
Catastrophes & Conflict Forum, Royal Society of Medicine; Faculty of Conflict & Catastrophe
Medicine, Society of Apothecaries, UK.
Ed Neale BSc MB BS FRCOG
Consultant Obstetrician and Gynaecologist and Medical Director, Bedford Hospital NHS Trust
Peter Old LLM FFPH MFFLM MRCGP
Medico-Legal Adviser, Medical Defence Union
Geraldine O’Sullivan MB BCh BAO MD FRCPsych
Executive Director Quality and Medical Leadership, Hertfordshire Partnership NHS Foundation
Trust
Sheila Peskett MA FRCP
Group Medical Director, Ramsay Healthcare UK, London
Alastair Scotland FRCS FRCP FRCGP FFPH
Director of the National Care Advisory Service (NCAS) (retired)
Philip Sugarman MSc MBA PhD FRCPsych
CEO & Medical Director, St Andrew’s Healthcare, Northampton; Visiting Professor, School of
Health, University of Northampton; Honorary Senior Lecturer, Institute of Psychiatry, King’s
College London
Sylvia Tang MBBS MRCPsych
Medical Director, Camden & Islington NHS Foundation Trust, London
Jayaraman Thiagarajan FRCA FFICM MBA
Consultant in Anaesthesia and Critical Care, East and North Herts NHS Trust, Lister Hospital,
Stevenage
viii
Preface
Health services across the world are under pressure to become more effective and to deliver better
quality care for less in the face of increasing demand related to demographic changes, the emer-
gence of ever more expensive treatments, and government pressure to limit the spend on health.
In the United Kingdom, it is no different with healthcare going through one of the most turbulent
periods in its history with the controversial Health and Social Care Act 2012 heralding big changes
in the configuration of healthcare organisations responsible for commissioning and provision of
care. Reforms involving the development of commissioning groups, abolition of Primary Care
Trusts, increasing competition with the concept of ‘any willing provider’ and the need to make
cost savings amounting to 20 billion pounds by 2015 pose significant challenges. Such substantial
savings can only be achieved through a considerable reduction of both managerial and clinical
resources. Therefore, the biggest challenge for all of us working in healthcare is to optimise the use
of available resources and provide a clinically effective and safe service within limited resources.
General practitioners and hospital doctors have been thrust to the forefront of this challenge and
given the responsibility of both commissioning and delivering these services.
We all agree that clinicians need to remain at the heart of leadership and management of the
healthcare system. But how well equipped are doctors in the UK to take on this challenge? Doctors
are trained to be clinicians and have very little management training as undergraduates. Therefore,
the majority are most comfortable within their own area of expertise and often have problems in
understanding and dealing with management issues that require entirely different training and
skills. Most doctors who choose to go into medical management have little knowledge or experi-
ence of matters such as commissioning, financial processes, managing people and dealing with
under-performance, how to manage meetings or function at board level. These are skills most of us
learn on the job through years of experience.
There are a range of books covering management in the corporate and business sectors but little has
been written on medical management. We developed the idea for this book because of this dearth
of books that comprehensively cover the various aspects of medical management in both primary
and secondary healthcare. We felt that there is a huge need for such a book particularly at a time
when doctors are taking a more prominent role in managing healthcare. We hope that this book, in
which almost every chapter is written or co-authored by an experienced medical manager, will be
of benefit not only to doctors engaged in management but also for a much wider audience includ-
ing undergraduates and non-medical managers.
The book has two main sections: general management in healthcare, and specific issues. The former
includes chapters on project and change management, patient safety and quality, health outcome
measures, leadership styles and skills, human resource management for doctors and information
technology and innovation in the NHS. The second part deals with specific topics such as the role
of the medical director at board level, the challenges for a clinical director, doctors in difficulty,
financial issues for doctors and enhancing personal effectiveness. We have been very fortunate in
recruiting several experienced medical managers from a range of specialities to contribute chapters
on a variety of settings such as acute care, mental health, general practice and private health care.
We have also had expert contributions on topics such as commissioning, clinical governance and
patient safety.