Martin McShane: Control

Martin McShaneHave some fun with Google. Type in “British Medical Association says yes.” It will give you about 650,000 results. Typing in “British Medical Association says no” gives you nearly 12 million!

Of course this is entirely specious, irrelevant nonsense. Or is it? Having crossed the floor from front line clinical practice to full time management, I have seen and experienced the full power and influence of the medical profession. It is a great force for good. Some of the most exciting, innovative and rewarding aspects of working in management have been due to the passion and enthusiasm doctors have for making the health system work better.

There is, however, a dark side. I was mulling over this after a recent PEC where Transforming Community Services had been discussed. An off the cuff comment had got me thinking. One GP said in the meeting: “If we had control of community services, it would be so much better.”

A few days later, in the quiet of my office, I shared a heretical thought with another GP. Perhaps it might be better if community services controlled general practice?

Rather than rising to the bait (he knows me too well) he reflected: “The problem with doctors is that they like telling people what to do, they just don’t like being told what to do.”

Since the inception of the NHS it has been recognised that engaging and involving the medical profession in shaping the health system is of paramount importance. Chris Ham refers to the difficulties of managing the health system because of the “inverted pyramid of power” in existence, in which the front line clinician has the greatest power to affect or subvert change. With such power comes responsibility. Truly respecting and valuing other people’s contribution leads to great team work. With health care being so complex, teamwork is essential. Being part of a team means accepting, sometimes, that other people tell you what to do.

At least if you Google “British Medical Association says maybe,” it gives cause for hope (2,800,000).

By the way, there is another question you can type into Google: “Doctors want more pay.” If you are of a sensitive nature, I suggest you don’t!

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.

  • Richard Smith

    Your blog reminds me of one of my favourite articles: Jim Drife on the “British Misery Association.” It begins:

    “Hello! As a BMA politician I believe one must keep in touch with the grass roots at the coal face. This is why I have found time in my busy schedule to pen this message to each and every one of you. The BMA is seriously concerned that some doctors (very few, I grant you) are happy in their work, and it is my urgent task to stamp this out.”

    You can read the rest at:

    But there are serious points to be made:

    1. As Enoch Powell argued, if you have an NHS funded out of taxation then all those within the system can do to get more resources, including for themselves, is to moan about deficiencies.
    2. It’s tragic that doctors, who are mostly very smart people, are often seen by politicians, policy makers, and managers as more part of the problem than part of the solution.
    3. Even more tragically, doctors—even GPs, who have remarkable influence within the system—too often see themselves as victims rather than leaders. I always remember George Alberti saying “There is no them. There’s only us.”
    4. Doctors do seem to have lots of problems with leadership, a theme I’ve explored in a talk available on Powerpoint but never written up. One of my arguments is that “Doctors create unleadable organisations and then elect compromise candidates to lead them.” The BMA may be the best example. You can access the lecture at: