Leadership and management for all doctors

Planning, using and managing resources

All doctors

79

Whatever your role or level in your organisation, whether you are a junior, non-training grade or other doctor, you should be willing to demonstrate leadership in managing and using resources effectively. This means that you should be prepared to contribute to discussions and decisions about:

  1. allocating resources and setting priorities in any organisation in which you work
  2. commissioning services for the wider population of patients.
80

You should have enough understanding of how finances are allocated and managed in the services in which you work to help with your role in committing resources for the benefit of patients.

81

To minimise waste, improve services and promote the effective use of resources, you should take financial responsibility for delivering your service at a level appropriate to your role. You should understand the roles and policies of local and, where relevant, regional and national agencies involved in healthcare if they affect your role as a doctor.

Doctors with extra responsibilities

82

If you are responsible for managing resources, or commissioning or delivering health services, you should have detailed knowledge of how management processes work and how they affect the delivery of patient care.

83

You must make sure that you are competent and have the necessary training or advice for any financial responsibilities that are part of your role. You must make sure that those you manage have the necessary skills and advice to fulfil their roles.

Allocating resources

84

All doctors must make the care of patients their first concern. However, the treatment options that can be offered to patients may be affected by limits on resources.

All doctors

85

If you make decisions about access to treatments on a case by case basis, without referring to agreed policy or guidelines, you risk introducing elements of unfair discrimination or may fail to consider properly the patient’s other legal rights. When making decisions about using resources, you must do the following.

  1. Provide the best service possible within the resources available, taking account of your responsibilities towards your patients and the wider population.
  2. Be familiar with any local and national policies that set out agreed criteria for access to a particular treatment.21 
  3. Make sure that decisions about setting priorities that affect patients are fair and based on clinical need and the likely effectiveness of treatments, and are not based on factors that may introduce discriminatory access to care.22 
  4. Be open and honest with patients23 and the rest of the healthcare team about the decision-making process and the criteria for setting priorities in individual cases.
21

For example, national service frameworks and National Institute for Health and Clinical Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) guidelines.

22

For example, a patient’s age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation or socioeconomic status. For further information see the Equality Act 2010. If you are working in Northern Ireland, see The Gaps between GB and NI Equality Law (January 2011), which sets out the differences between the legislative framework and protections in Northern Ireland.

23

And those close to the patient where the patient lacks capacity or has asked you to communicate with a family member, carer or friend.

86

You should involve colleagues, including other healthcare professionals, in discussions about how to allocate wider resources. If issues or disputes about allocating resources arise, you should try to sort them out by discussing options with, for example, patients, the healthcare team, other colleagues (including other health and social care professionals) and managers. You should be open and honest with patients when resource constraints may affect the treatment options available.24 

24

Communitybaptistpa (2008) Consent: patients and doctors making decisions together London, Communitybaptistpa, paragraph 9.

Doctors with extra responsibilities

87

If you have a management role or responsibility, you will often have to make judgements about competing demands on available resources. When making these decisions, you must consider your primary duty for the care and safety of patients. You must take account of any local and national policies that set out agreed criteria for access to particular treatments and allocating resources, and make sure that these policies are available to clinical staff.

88

If you are concerned about how management decisions might conflict with your primary duty to patients, you must take steps to manage or deal with any conflict; for example, by:

  1. asking for colleagues’ advice
  2. declaring the conflict to your board or other decision-making body
  3. asking for advice from external professional or regulatory bodies, including defence organisations, if necessary.

Honesty, integrity and conflicts of interest

All doctors

89

If you have financial or other personal interests in organisations providing health or social care, or in products used in health or social care, you must follow the advice in Conflicts of interest 25 and in Medical practice 5 

25

Communitybaptistpa (2008) Conflicts of interest London, Communitybaptistpa.

5

Communitybaptistpa (2013) Medical practice London, Communitybaptistpa.

Doctors with extra responsibilities

90

If you are responsible for managing and allocating funds or resources, you must make sure that they are used for the purposes they were intended for and are clearly and properly accounted for. You should also make sure that appropriate professional services, including audits, are commissioned when necessary.

91

You should make sure there are adequate systems in place to monitor financial and management information. You and those you manage should make full use of these systems, including when awarding contracts and managing waiting lists and service plans.

92

You must make sure that there are appropriate systems in place to make sure that actual or perceived conflicts of interests are managed in an open way, and in line with the guidance in Conflicts of interest 25 and Medical practice.5 

25

Communitybaptistpa (2008) Conflicts of interest London, Communitybaptistpa.

5

Communitybaptistpa (2013) Medical practice London, Communitybaptistpa.