In the United Kingdom, consultant psychiatrists in the NHS are not automatically part of a fixed line management structure although their job plans have to be agreed with the chief executive either directly or through clinical and medical directors. At present, a consultant is not answerable to a manager in a clinical situation, although this will change with new structures about to be implemented and with the introduction of clinical governance. However, the consultant psychiatrist is the essential unit of management who looks after individual named patients and working with a multi-disciplinary team. Ideally, it should be the business of all levels of management to empower individual consultants so that they can practise effectively; a group of consultants should be able to share their resources and individual consultants should be able to control their clinical resources to make their clinical services as effective as possible. (2) The psychiatrist (at a consultant or equivalent level) wears several hats—some are by virtue of his or her clinical expertise and others are due to personal interest and managerial expertise. Some of these are discussed below.
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