A year in management

How would you like a medical job with good money (£55 000 plus), flexible hours, and no on call? It sounds good—but it does exist and I have just given it up.

Perhaps not too many people have moved from being medical director to medical senior house officer, an experience which has given me a unique view of two sides of the NHS. One is a world of crowded corridors and peeling paint; of patients, bleeps, and telephones. The other is of conference suites and hotels, meetings and minutes of meetings; coffee cups and biscuits.

There has been an explosion of new managers into the NHS since 1990—20 000 or so. In every town of any size there will be a listed building, converted stately home, or modern office block full of them.

Many managers have come into health from business, bringing “market skills,” but others have come from within the NHS, especially nurses, therapists, and doctors. Some maintain a clinical commitment, but many do not, and they rapidly take to sharp suits, mobile phones, and other trappings of their new trade. It is often reckoned to be a …