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Clinicians and managers work in a range of settings across primary and secondary care. In 2013 the NHS alone employed 147,087 doctors, 371,777 qualified nursing staff, and 36,360 managers.1 This paper focuses particularly on the relationship between clinicians and managers within acute settings, although some of our recommendations may apply to other sectors.
The NHS has, for a number of years, been widely perceived as being in the grip of a ‘leadership crisis’, with many key posts unfilled or filled by interims, and a high turnover of senior staff. A third of NHS trusts have vacancies for key leaders at board level or interims in post. Almost one in six have no substantive chief executive, and the same number have no substantive medical director. At present, the average tenure of an NHS chief executive is only two and a half years.