Clinician managers and cultural context: comparisons between secondary and primary care

This paper takes account of earlier work suggesting that cultural differences between clinical specialties in the hospital sector are an important indicator of the extent to which different specialties are able to engage successfully with managerial roles. This study suggested that some clinical specialties, particularly non-acute and support specialties, were more predisposed to managerial work, whereas acute clinical specialties, for example, surgical specialties, or obstetrics, tended to be more sceptical and in some cases antagonistic towards managerial work. These findings are compared with the emerging experiences of GPs faced with the challenge of similar managerial situations. The findings point to the existence of different cultural groups, or subcultures, co-existing in both the Trust and to some extent in the PCG. Some clinical specialties were prepared to share managerial values and expectations or at least go along with them, while others were antagonistic and represented a potential source of conflict. The evidence in the two sets of data points to two broadly defined groups: traditional professional and managerialist subcultures. The existence of these cultural sub-groupings is significant in terms of support for or against doctor involvement in the managerial process.