The Role of Health Professionals

The Role of Health Professionals

DOI: 10.4018/978-1-7998-3928-6.ch003
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Staff governance is a major challenge for the NHS. It refers to the framework for managing employees in the National Health Service (NHS). Professional practitioners, in particular doctors and nurses, have a key role to play in the running of the NHS, but there are many challenges in managing staff and especially ensuring high retention levels. This chapter begins by explaining the power relations within the NHS and among some of the key actors. It then highlights some of the key challenges including those posed by the loss of European Union (EU) staff following the UK's decision to leave the EU. In particular, it explains why it has become increasingly difficult in recent years to retain staff in the NHS. It then discusses some of the measures to stem the haemorrhaging of staff.
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Power Relations And Frontline Staff

The medical profession is represented at all levels of decision making in the NHS. For example, in the Department of Health, the Chief Medical Officer and NHS Medical Director are senior doctors. National clinical directors from this professional corpus are also present in the department to lead policy on clinical priorities such as cancer and coronary heart disease (Ham, 2009). In the Clinical Commissioning Groups (CCGs), which now govern the administration of health services at the local level in England, many of the senior managers have a medical background (for example many of the clinical leads and other CCG managers are senior nurses). The principles of resource management are based on involving senior practitioners in the management of hospitals and primary care, inherited from the clinical governance framework set up by New Labour.

According to historian Rudolf Klein, the creation of the NHS in 1948 was not necessarily welcomed by doctors. He underlines that the NHS has continued to have a power struggle ever since of ‘keeping the doctors happy’ while still making them accountable and adhering to reforms and governance principles (Klein, 2013). Politicians and health managers continually struggle to push through reforms because of the influence of doctors and nurses resisting them. The essential governance struggle between politicians, administrators and clinical practitioners has been over the latter arguing that the former two do not understand clinical needs, and therefore any political actions regarding the NHS will have unforeseen results. Since its conception, doctors have seen a move from complete independence, before the creation of the National Health Service, to semi-independence in the early days when doctors ‘just got on with their work’ and ‘didn't have to report to anybody’ to the situation today where managers from outside have altered the nature of the power and leeway of doctors and nurses. This is particularly the case in England which has seen a move towards market governance.

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