The role of the Medical Director



The medical director is the manager of the medical consultants. The speaker likened it to being a bit like Manchester United. The medical director is the manager and the players are the consultants.

The players need to be kept as happy (through good management), with good team-working and the best possible patient outcomes. There are 350 consultants in this hospital. This was the model that Salford adopted. Focus on valuing your consultant workforce and focus on safety.

Recruiting Consultants

In recruitment terms: IBM would probably spend days recruiting people over a several day interview. John Lewis has a much flatter structure. The Princes trust has a different structure. All the decisions are values based decisions in these above organisations.

The NHS is still often using older models based on short 1 hour interviews. This causes some problems when it comes to medical recruitment and allows some of these different characters into the consultant workforce. Some of the more eccentric types include:


The difficult ones – professors etc. Lots of idiosyncrasies. Need a few but only a few.


The throw the toys out of the pram type – poor insight. They will cause fights and distract department focus.


The Mr Burns type – moneybags. They will drain resources.


Saboteurs – few but very destructive. Even one of these can decimate your department or even your hospital.

It has to be emphasised that these groups do not represent the majority. The last 3 – no insight, Mr Burns and Saboteurs that they are trying to screen out. Some ‘professors’ are necessary but only a few.

The Medical Directors’ Roles

The Medical Director has to deal with Job Planning, Doctors in difficulty, SUI’s (serious incidents), SIRI’s (serious incident report investigation), Conflicts, Dysfunctional Departments, Consultant morale, Trust performance, Patient safety, Clinical performance.


The Consultants

Everyone will look at the consultants to lead and make decisions. They are the leaders in the hospital.

They are the key decision makers. They may be perceived as difficult from the outside and sometimes from within but they have to think differently because they are key decision makers.


The key question is where do you put them? They are a finite resource and you need to put them where they are most required.

The consultants need to be team players. They need to teach and manage. They need to know the business. They are the guardian of the quality agenda and outcomes. They forge partnerships between doctors and management. They have to be adaptable.

Previously there have been clinician lecturers, clinician scientists/researchers and clinician service providers. However, now the clinician manager is coming to the fore.


The idea is that clinicians will be forming and developing their services. We shall see whether or not people engage with this.

At the end I asked the group how many would consider becoming a clinical manager as their primary role. At least a quarter put their hands up! Impressive. Perhaps there has been a significant scene change of late.

Role of the AHSN’s – Academic Health Sciences Network #NHSClinEnt



AHSN network for the North West Coast

2/3rds funded by NHS England. 1/3rd funded by industry. They act as brokers in the system and are not tied to any particular side.

There is a local board made up of 45 people including patient, government, clinical and industry representatives. They will take innovations and try to help scale them within the NHS by building products into pathways. They link to the NIA – National Innovation Accelerator. This can then lead to products going on the NHS tariff’s and ultimately saving lives.

This is a map of what they do:



They have an innovation exchange which includes:


They have scouts who help to champion various innovations:


Then then use bags to carry around innovations to perform market research.


Can UX Improve the NHS? #GiantHealthEvent

Panel chaired by Dr Gyles Morrison of Dr-Hyphen.

UX is shorthand for user experience design. It is a hot topic at the moment, particularly as ‘UX experts’ like Apple move into healthcare.


The premise was put to the group that NHS UX tends to suck. However, it is not just the user interface that needs to change but the problem needs to be looked at holistically from all angles. It’s no good if a piece of software becomes easier to use at the cost of overall utility. There will also be knock on – unexpected effects which UX seeks to solve. For instance the interface might look good and become very usable, but if the system slows down as a result this is an un-acceptable trade off. what-exactly-is-ux-design-01

Some of the panel then made the point that clinicians and frontline staff are not consulted by any of the decision makers. One of the panel members – an orthopaedic surgeon believes we need to fight back against the legacy systems we currently have.

One of the audience then suggested that part of the issue is commissioning. Managers will look for the simplest single solution that ticks the most government boxes and UX doesn’t come into it at all. He gave the example of script switch which almost invisibly switches your script around, saving money and time.


UX crosses the boundaries of lots of different sectors. The orthopaedic surgeon then told a story about consultants in his hospital being told to see patients within 14 hours of their admission. This was agreed with the CCG than the hospital would hit a 90% target of achieving this. This was not discussed with the consultants until after it had been agreed. They then realised they had a major problem – the staff had no buy in and the managers had no mechanism to actually measure their success.

The GP in the audience then argued that the problems we are trying to solve are normally artificial. We should rather be working out which steps add value to patients, clinicians and managers.

One of the other panel members suggested that the key is to solve a single problem rather than try to tackle many problems at once. I then suggested there is a danger here that we end up like the app market where there are multiple individual proprietary platforms all competing together for money. This could lead to an increasingly fragmented health service which may not serve patients well.


All were agreed that empowering patients therefore is important, but how this happens and how we cater for patients’ future needs will be key to whether or not we succeed in creating a better future for all patients or only some.