Engaging leadership: hope for the future lies with a new breed of doctors

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With a few exceptions, medical students have little, if any, training in management, leadership and service improvement. Yet from the moment they graduate, doctors require a range of such competencies, which become more important as they progress to become consultants and general practitioners.

Early exposure to management and leadership should provide the foundation for an NHS in which doctors appreciate their responsibilities to others within the multi-professional team, the organisation and local health community as well as to their patients and themselves.

The joint 'Enhancing Engagement in Medical Leadership' project led by the NHS Institute for Innovation and Improvement and The Academy of Medical Royal Colleges, after wide consultation, has developed a Medical Leadership Competency Framework (MLCF) that describes the key competencies required by medical students, postgraduate doctors and those in continuing practice. The framework has been adopted by the General Medical Council (GMC) and all the Royal Colleges and is now slowly but surely influencing undergraduate and postgraduate specialty training. It has also been accepted by all clinical professions and forms the basis of the new NHS Leadership Framework.  

The new Faculty of Medical Leadership and Management (FMLM) has created an opportunity to promote the advancement of medical leadership, management and quality improvement at all stages of a doctor’s training and career. It has an important role to spread good practice and to support initiatives that will make the incorporation of the agreed competencies into curricula and experiences both stimulating and relevant.

As well as a growing recognition that junior doctors need to develop management and leadership skills, many medical students and postgraduate trainee doctors are increasingly being attracted to the study and application of service improvement methodologies. A study by Gilbert et al (2012) concluded that doctors in training have a desire and ability to contribute to improvement in the NHS but do not perceive their working environment as receptive to their skills. Junior doctors who attend leadership training reported higher levels of desire and ability to express these skills. The study suggests that junior doctors are an untapped NHS resource and that they and their organisations would benefit from more formalised provision of training in leadership.  

There are already some exciting initiatives that support junior doctors to lead improvement, such as the Darzi Clinical Fellowship programme (supported by The King's Fund) and the NHS Medical Director's Clinical Fellows Scheme (run by the FMLM). There are also a number of regional programmes, including those led by the North West Deanery and the Kent, Surrey and Sussex Deanery, which link doctors and managers in their development programmes.

To encourage further adoption of the medical leadership movement, it is important to share which initiatives are being incorporated into undergraduate and postgraduate training, and to analyse and assess the impact of the different approaches.

Our next leadership and management review, due on 23 May, will explore the theme of 'engaging leadership'. It will examine the growing evidence that securing greater engagement of staff generally – and doctors in particular – in leadership leads to a higher quality of care and greater productivity.

We support the development of clinicians at all stages in their careers - find out more about our leadership development work.

This blog is also featured on the British Medical Journal website.

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dr abdul shakoor

GP principal,
Comment date
27 July 2012
thankyou for a very lucid and factual report.

after 10 years as a frontline GP if feel ready to develop further skills to become a clinical leader in the NHS and help to develop and strenghthen the core values of this great British Institution.

Simon Knowles

National Clinical Advisor,
NHS Improvement
Comment date
14 May 2012
"Well defined quality improvement projects can deliver rapid learning"

Well said, Tricia. If we build our leadership development around quality and process improvement then the need for clinical engagement becomes a compelling story.

Our tradition of treating improvement as a bolt on extra - something a leader has to fit in after the daily crisis interventions - simply won't deliver the new leadership we need across health and social care.

Alexandra Gilbert

ACF ST4 Clinical Onoclogy,
Leeds Teaching Hospitals NHS Trust
Comment date
09 May 2012
Thank you so much for acknowledging my recent article.

I'm really glad that the importance of management and leadership training has been taken seriously in junior doctors and it's great to hear about the initiatives in KSS and the North West deanery.

I also would like to draw attention to the excellent work going on in South Central that enabled me to carry out my research. I feel it is important to highlight that it was through the fantastic South Central and Wessex regional multidisciplinary leadership and educational programmes that I was inspired, and supported, to carry out this piece of work.


Comment date
01 May 2012
I agree that there is a vast untapped resource out there; people with on the ground experience, lots of energy, and maybe at a time when they can make time to act.
There are also people for whom leadership is not right. Medicine has a vast array of specialities and skills, doctors are by no means all skilled in the same way, and can choose their path to suit. Care needs to be taken not to set curricula or modules which are not attainable or relevant to some (maybe because it would serve the NHS if everyone could be called upon to step in/up?)

Tricia Woodhead

Consultant radiologist, Director of Quality & Health Foundation Quality Improvement Fellow 2010,
Weston Area Health Trust/ NHS South
Comment date
26 April 2012
At last weeks BMJ/IHI International Forum on Quality and Safety it was inspirational to see so many posters and presentations demonstrating the significant input that junior doctors are making to healthcare delivery improvement. This is tangible evidence of the value of this untapped resource. Working in and on the system builds clinical and leadership competence in any clinical trainee. Well defined quality improvement projects can deliver rapid learning and significant impact across an NHS organisation. It is my view they should be part of the Foundation program and the methods they use become part of the final year medical school curriculum 'preparing for professional practice'

Simran Minhas

clinical fellow in leadership and anaesthesia,
Comment date
26 April 2012
The sentiments in these comments and the blog, I agree with wholeheartedly, and things are beginning to blossom in the two deaneries mentioned.
However, other deaneries are not interested and medical training has evolved to encompass many years in most specialties often with many changes of workplace.
These two areas need to be addressed so that those at junior medical level, who have huge amounts of energy and ideas and drive, can be a recognisable driving force in improvement projects, knowing that their work will be well supported by senior colleagues and the institutions they work for.
At present we are an entire workforce who come to work, fulfil service requirements, complete our training requirements somehow and achieve CCT, as an almost entirely separate entity to what is actually happening within the healthcare arena or even within the hospital itself.
Approaching the end of my year in a clnical fellow position in leadership, it is interesting to reflect upon the fact that in most hospitals you need the title consultant to have a voice, and yet that same group of 'consultants' often dont use their collective voice to its full potential.

Stuart Sutton

GP Darzi Fellow,
Comment date
26 April 2012
Absolutely agree with the fact that junior doctors are an untapped resource - as current Darzi fellows we try to spread some of the leadership and service improvement knowledge and skills we have learnt to other junior doctors. Most have a clear grasp of how services need to improve and how to achieve the required changes but don't feel empowered or recognised by their organisations. Perhaps more distributed leadership throughout NHS organisations may feed into a culture of junior doctor engagement in service improvement? There's an army of potential agents of change out there - the challenge is how the NHS can mobilise them to reap the benefits.


Kinnear Consulting
Comment date
26 April 2012
Great article. Doctors get to a certain stage in their career and are suddenly expected to be ready to take on leadership and management roles. It's great to see an increasing number of initiatives to expose medical students and doctors-in-training to leadership, management and service improvement at a much earlier stage. We still have a way to go in Northern Ireland as we don't yet have the equivalent of the Darzi Fellowships or the NHS Medical Director's Fellowships but it's great to see a student-selected component for 3rd-years at QUB called 'Follow The Leader'. It's run by Dr Melissa McCullough and allows medical students to shadow a number of leaders in Health and Social Care organisations. I had the privilege of recently hearing the students recount their experiences and what they learnt from this and it was very powerful.

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