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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 December 8; 335(7631): 1175.
PMCID: PMC2128636

NHS doctors and finance staff have a negative view of each other

Doctors must be involved in financial decision making in the NHS to avoid repeating the cash disasters of recent times, England’s public spending watchdog says.

The Audit Commission has published a report calling for much better communication and working relationships between clinical and finance staff. The NHS will become more efficient and will improve services for patients only if relationships between these two groups of staff are stronger, says the report.

Failure to engage doctors and other clinical staff in managing budgets is at the heart of financial problems in the NHS, say the authors.

They interviewed staff at 16 different NHS sites—acute, foundation, and primary care trusts—in preparing the report, which is aimed at clinicians, managers, and finance professionals.

Their work showed that the two professional groups held some firm negative stereotypes of each other, say the authors, but they also found good examples of clinical and financial staff working together to improve the quality and efficiency of services.

The report identifies several practical measures to promote better joint working, including:

  • Training clinical staff in financial management
  • Providing more timely and accurate financial information, and
  • Increasing the visibility of financial staff and improving their knowledge about the delivery of care.

The report says, “In the past, managing the money was often seen as the preserve of the finance department, but this approach will not stand up to the demands of the new NHS. Closer alignment of finance staff with the ‘front line’ will improve key aspects of financial management.”

It provides a checklist for chief executives, finance directors, and medical directors covering issues such as governance and accountability, communication and culture, the importance of good information, and commissioning and purchasing.

Steve Bundred, chief executive of the Audit Commission, said, “This is about giving power and responsibility to those in the very front line.

“Most NHS money is spent by doctors and other clinical staff. It is they, rather than finance managers, who are best placed to identify how funds can best be used to improve the quality and efficiency of services.”

Jonathan Fielden, chairman of the BMA’s consultants’ committee, said that the report was further evidence of the association’s repeated calls to “put doctors and other clinical staff back in charge of the NHS.”

Dr Fielden said, “For too long, finance has been used as a barrier to innovation and progress.

“It is to be hoped that this report signals a change in direction, putting quality and clinical care for patients first.”

A spokesman for the NHS Confederation, the body that represents most NHS organisations, said, “Improving efficiency and ensuring that money is spent effectively are only possible with a high level of clinical advice.

“Most of the money spent in the health service, after salaries, is the direct or indirect result of decisions taken by clinicians. It is essential that they are closely involved in the process of allocating resources.”


A Prescription for Partnership: Engaging Clinicians in Financial Management

can be seen at

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