To be, or not to be, a clinical director... but is that the question?

Recently I've been thinking a lot about the role of clinical director. We've just said goodbye to the 2014 cohort of our Clinical Directors and Lead Clinicians programme – a fantastic group of clinical leaders who are, or are aspiring to be, clinical directors. In addition, I have also been working with colleagues on a number of organisation-based programmes commissioned to support clinical directors.

Through this work I’ve been particularly struck by the potential influence these roles can have across the system, particularly when they work collectively to initiate change. But for the true potential of clinical directors to be realised, I have a hunch that we need to think about the role completely differently.

The tensions inherent in clinical director roles are well known, doubtless best by doctors themselves: not enough time to undertake the role in full; anxieties about maintaining clinical expertise and credibility; tensions between professional and corporate accountability and responsibility; a sense of having to lead beyond perceptions of formal authority, especially when managing clinical peers; and, of course, the inevitable issues that come with transitioning first into and then ultimately out of the role. I could go on.

Nevertheless, my sense is that the days in which the ‘next person in line’ would automatically take on the clinical director role, or that a colleague would agree to do it simply because no one else would, might slowly be becoming a feature of the past. Instead, I increasingly meet clinical leaders – primarily doctors – who are making an active decision to prepare for, and take on, the responsibilities of clinical director or lead clinician. Many have been inspired by previous role models; have a burgeoning interest in medical leadership; or wish to make a difference to their organisation, particularly around improving high-quality, compassionate care for patients. But very often these individuals have very little idea about what the role might really entail or the necessary language, behaviours and leadership practices required to undertake it successfully. Little wonder then that our programme for clinical directors and lead clinicians is always oversubscribed.

Deep and genuine clinical engagement is needed to address the current challenges facing the NHS, not least in light of the NHS five year forward view. Whatever the political landscape after the general election, the need for ongoing efficiency savings and the drive for more integrated care alongside new models of clinical service delivery make it imperative that clinicians are able to bring their expertise to bear when difficult decisions have to be made around how, or indeed whether, clinical services are best provided in future. My sense is that the roles of lead clinician and clinical director are going to be particularly crucial against this context.

The vast majority of lead clinicians and clinical directors undertake their roles in the absence of clearly defined job descriptions. Indeed, there seems to be very little consensus about the role among the professional bodies. Perhaps there is an opportunity for these roles to be locally or nationally defined – which I believe they must be in order for those who occupy them to be able to work with any degree of devolved responsibility and accountability, and with an appropriate level of authority. This is certainly a key feature of the four NHS trusts we have highlighted in our recent report on medical engagement, and of high performing organisations such as the Mayo Clinic, Intermountain Health Care and Salford Royal NHS Foundation Trust, which we heard about at our conference yesterday. At The King's Fund we will continue to work with organisations such as the Faculty of Medical Leadership and Management on the process of professionalising and validating medical leadership.

So it seems to me that the question right now is less about whether to be, or not to be, a clinical director and more about agreeing a local or national consensus around the expectations of the role. A clear commitment from stakeholders across the system is needed to ensure that those who are choosing to take up this and other challenging clinical leadership roles are adequately supported, developed and only then held to account. 

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