Psychiatrists are key members of staff in mental health trusts and the relationship between them and the trust management is crucial to the dayto- day running and development of the organisation. Ideally, psychiatrists should work together with the management team in a collaborative way, in pursuit of a common goal. Unfortunately, in some cases this happy circumstance does not occur and there can be mistrust and antagonism between the two groups.

In most mental health organisations, psychiatrists have a management position, as a medical director, a clinical director or a lead consultant. Such psychiatrists usually continue to have some clinical responsibility. Indeed, one of the challenges of these positions is to retain credibility with both clinical and management colleagues. Without continuing clinical work, it is difficult to have either credibility or up-to-date knowledge of issues ‘on the ground’. However, this dual responsibility can often cause tension and conflict. Effective medical managers can play an important role in developing a collaborative way of working and encourage psychiatrists to have a degree of corporate responsibility while maintaining professional standards.

The role of a medical manager is usually very challenging and can be stressful but at the same time can be exciting and enjoyable. It is important that a medical manager must not become too closely identified with one or other constituency. In other words, he or she must not become too much of a manager nor too much one of the consultant body. The difficulty of the job will depend on the context of the service at the time. It is easier to do the job at times of stability and development of services; it is less easy when money is short and services are contracting. The current environment is particularly challenging.

Medical director

Role of a medical director

The portfolio of the medical director can vary from trust to trust. In a foundation trust the medical director is one of the mandated executive directors who sit on the main trust board. Medical directors usually have the responsibility of ensuring that appropriate systems and mechanisms are in place to safeguard the quality of the clinical service.