Sharing experience with aspiring medical leaders

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The King’s Fund works with clinical leaders at all stages in their careers and we believe that clinical leadership and engagement needs to be a priority across the NHS. This is the first in a series of guest blogs that explores current issues and opportunities for clinical and medical leaders.

I’ve never really been one for looking back, or thinking about how I would advise my former self, but I am passionate about encouraging aspiring medical and clinical leaders.

The best health care organisations in the world are clinically, usually medically, led. The United Kingdom lags far behind. Now is the time for the profession to take up the challenges of health system leadership. Our NHS, our country really does need you.

Only the other weekend I was at an excellent medical leadership programme at the Royal Berkshire Hospital in Reading. The room was full of budding medical leaders, showing that the future of the profession and health is more vibrant than many would suggest currently. This is the first thing that I would pass on to aspiring medical leaders: you are part of, and will remain so as long as you wish to, the best possible profession, one that is a privilege to be part of and an amazing job; not just a profession, but a vocation. A profession that you should remain passionately linked to, nurturing the visceral burning ambition to improve the care for patients that brought you into it.

In short: hang onto your dreams. One of the grave sadnesses of the current disputes on contracts is that many may well lose sight of the dreams and aspirations that brought them into health care. I would urge otherwise; this ambition is what drives us to better care, and achieving the most enjoyable aspects of being a physician in its widest sense.

I would also recommend that aspiring medical leaders build a personal philosophy, one on which to set your foundations, one to check and hold fast to when the inevitable challenges to you, your decisions and the service in general come thick and fast. My personal philosophy has been threefold. First, ‘patients first’ – whenever decisions are finely balanced or you are not sure which way to turn, think patients first: ‘what difference would this make for patients’ as Don Berwick would say.

Second, always aim to ‘drive value’ – in everything you do always try to improve the quality of outcomes and experience for patients, while also being aware of the cost of achieving that – an approach best articulated in 2010 by Michael Porter. There is always a limit to the funds available to health care, and so medical leaders are guardians of effective spending.

The third aspect of my personal philosophy is always try to make where you work the best place to work, train and learn. Happy staff, cohesive teams, celebrating excellence repay you many times over multiply. The return on investment of encouraging staff and colleagues is huge, both in financial terms and most importantly quality of care. Those damaging people’s belief in our profession must understand the risks that this brings. Medical leaders must ensure that while pushing up system outcomes and performance we invest in personal and team development; the essential third leg of quality.

My next recommendation is remember that life is short. Understand that while there will always be many calls on your time, your skills and your expertise, time never runs backwards. Your children never grow younger, that missed opportunity for a holiday never comes back and no one thanks you for working too long. Value time out, give yourself time to think. Fight the urge to always be at work. Sometimes being with your family, friends or just your thoughts is the right way to recharge, refocus or be ‘mindful’.

Next, if in doubt, remember to just make that leap. I always worry more about the decisions that I haven’t made than the ones I have, even if wrong. Seek forgiveness, not permission. Too many organisations are hamstrung by bureaucracy and unnecessarily excessive governance and assurance. Necessary assurance is important, conservative desire for re-assurance so often misses the moment for real effective change.

Finally, if nothing else, remember to smile. Smile at yourself in the mirror first thing in the morning – it will empower you for the day ahead. Smile at the first person you see as you walk into work – at the very worst they will just think you’re strange. A smile is one of the lowest-cost, highest-return investments that you can make in yourself or others. Smile.


Dawn Castles

Business Manager,
Comment date
27 November 2015
Hi Jonathan,

It was a joy to read your article, I agree with everything you say. I left the Nursing profession a number of years ago which I often feel quality about, however I've spent the last 10 years supporting NHS staff clinical and non-clinical with patient outcomes, patient experience and quality & efficiency.
I work with Richard Coombes supporting your Trust, I would really appreciate 1 hour of your time to discuss how we can support you and your patients further.
Best regards
Dawn Castles

Umesh Prabhu

Wrightington Wigan and Leigh FT
Comment date
29 November 2015
Dear Jonathan very well written. Good leaders job is simply to make great leaders and inspire them to do a good job. You are absolutely right about medical led organisations. In UK sadly NHS has never nurtured, trained good doctors to be good leaders and many good doctors even today tell me 'Umesh I studied medicine to be a doctor and not to be a leader or manager'!

What I really find disappointing is when some of our very good consultants take the pleasure in calling me a 'manager' and I keep on reminding them I am a doctor, leader, manager, patient, servant and most of all their friend. One whose main job is to work with them, inspire and make them all great leaders so that our patients get the best care and all our staff are happy at work place and everyone feels valued and integral part of the organisation.

I really enjoyed reading your blog and time is right for many good doctors to take on leadership roles and become good leaders. I always tell our youngsters 'Be a leader but always be a good leader. You are as good a leader as your followers think or feel you are.

Qaim Zaidi

Project Manager,
Comment date
30 November 2015
Dear Jonathan
Brilliant blog , I enjoyed reading it. I’m not a doctor or a nurse, but anyone can learn from your advice. I’ll be forwarding this article to my son a highly paid junior doctor who along with his colleagues must be finding it difficult to smile at present, when accused of ‘a disgraceful dereliction of duty’ by the popular press.
You’re so right about taking time out for your family and friends, at times I missed on that but now I’ll heed to your advice and will enjoy my grandchildren, when they arrive.
I’m just smiling today even when at my desk and I am feeling great, colleagues’ keep on smiling,make this world a happy place...

Pearl Baker

Independent Mental Health Advocate and Advisor/Carer,
Comment date
01 December 2015
I am not medically qualified, but an 'expert by experience. My suggestion to a GP Practice which I recently transferred to was taken seriously and implemented: my previous GP Practice had this in place for years, and my working lunches with the Senior Partner identified problem solving. (sadly retired)

As a Carer, we now have rights in LAW for the first time.

Carer status will be identified on your medical records, and a Register will be held by the Receptionist.

Carers will be given 'Priority Appointments' and not be expected to wait weeks for an appointment, for obvious reasons.

Those we care for will also have the Carers name on their medical records.

The suggestion above works both ways.

My other suggestion as a Carer saw the introduction of 'dosset' boxes for those finding it difficult to remember what medication they have taken.

This again has been taken up by GPs.

The Pharmacist again is another area I have worked on, and in this respect my name appears on their system, where I am contacted by telephoned if a collection has not been made.

My recent suggestion of how GPs time could be utilized better by implementing my idea involving Pharmacist was well received by 'both'.

Members of the Public, Patients, would first visit the Pharmacy as many do. Pharmacists are often restricted by not having access to patients medical records, this can be overcome, by 'informed consent'.

Pharmacist unable to offer advise, because of their condition, or 'PRESCRIBE' need to access their MEDICAL RECORDS.

The individual will state their name, and GP Surgery (town, city)
this will be confirmed by the individual, the patient would then enter their 'PASSWORD' just like a 'PIN' in fact it could be a Pin number.

The Pharmacist would then be able to prescribe certain medication as the patients Medical Records allow or refer to GP 'Out of Hours' other agency as appropriately identified on the Patients Medical Records.

'Safeguarding' is a serious issues, only known Carers and others identified on the patients Medical Records will have access to this service.

It would be useful if the Carer's were issued with an NHS Card confirming their status, however without the 'PASSWORD' which must be entered by them no access is allowed.

Pharmacists obtaining access to Patients Medical Records would also write what action if any on the Medical Records, including referring to other agencies.

I would like to give an example on how this could work. The Pharmacist in question prescribes medication for 28 days always ending on a Sunday, Monday Bank Holiday no medication and your chosen Pharmacist is closed, but Not 'Out of Hours' my suggestion was passed by a GP and a BOOTS Pharmacist who both thought it a brilliant idea.

It will work along the same lines of Electronic Prescribing, which in fact was another idea of mine, at the time a GP said she would not have the time to do it, but here we are a great idea.

Pharmacists have Computers. GPs have access to their Computers, the add on is the important element 'informed consent'.

I was a member of an NHS Committee looking into how we could overcome 'Confidentiality' years later here we are, but my suggestion regarding GPs utilizing their time by working with Pharmacists better could be carried forward. It needs a little 'fine tuning ' but it can work, and parts do already.

I am NOT medically qualified, but remember you can learn an awful lot about everything when you have been an Independent Mental Health Advocate and Advisor/Carer for thirty years.

Carers are needed for our expertise in the real world, and many have learnt to 'cope' despite the 'obstacles and hurdles' they we have to jump over.

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