Hierarchy in the NHS; what is it and do we need it? Arguably, if you don’t have organisation, you risk chaos. So how does hierarchy help and how does it interplay with collaboration and coproduction? Do we really need hierarchy in a modem NHS as we need it in government? I would advocate that good hierarchy provides decisive leadership with swift decisions that allow progress - be that in the right or wrong direction. I think good hierarchy is kind, assertive, collaborative and unambiguous in the decision-making process. Bad hierarchy, in contrast, is authoritarian, cold, unilateral and unclear in making and communicating decisions. A bad heirarchy can create challenges for GPs on a daily basis.
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