Why is medical leadership important in the health service? 

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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 third in a series of guest blogs that explores current issues and opportunities for clinical and medical leaders.

I have been a consultant physician for less than a year and, rather unusually, my role is split 50:50 between delivering direct clinical care and medical leadership.

I have always had an interest in leadership roles, and in the last two years of my training I was recruited as a Health Education North West Leadership Fellow, undertaking a programme that was fully integrated into clinical training. This involved bespoke training with The King’s Fund as well as undertaking a Masters in health care leadership. I remember on the first day of the Masters course feeling distinctly in the minority as a doctor. One of the cohort turned to me and said, ‘You’re a doctor? Why are you doing this course then?’.

It perhaps wasn’t a completely unreasonable question; after all I had spent the previous 13 years learning the art of medicine, undertaking research and training to be a respiratory specialist. My skills were in treating disease, communicating with patients and families in their darkest hour, and practical things like putting in chest drains – so what was I doing there?

Over the next two years l studied a number of areas: patient experience, team effectiveness, delivering co-ordinated care, co-design of services, organisational development, systems leadership, as well as my own behaviours and skills. I realised how incredibly lucky I was to have frontline experience of health care alongside this. I was seeing sick patients in resus at 3am and running the acute take, but I was also being trained to think like a systems leader and starting to contemplate the ‘bigger picture’.

I was surprised by how far removed from direct care delivery many people in senior management positions were, yet these were the individuals who were setting strategy and shaping major change. I started asking: ‘Why are doctors not more involved? Why don’t we care more about the stuff that isn’t “doctoring”?’

I began to understand the different perspectives of managers and doctors and how, despite the common goal of delivering safe patient care, the hierarchical nature of NHS organisations and the slightly differing priorities of people at various levels often culminated in conflict and resentment. I realised that organisations often seem to forget that they are made up of individuals who need help, support and care to do their job properly and that a demoralised workforce is not good for patients.

A particularly interesting workshop we undertook on the Masters course was running an imaginary organisation and having to divide ourselves into ‘tops, middles and bottoms’, representing the executive board, middle management and the front line respectively. It was amazing how quickly ‘tribes’ formed and feelings started to run high, particularly among the ‘bottoms’ who felt disempowered and angry. This exercise lasted about two hours. Having been a ‘bottom’ for 15 years, and still considering myself so, I feel privileged and excited to be leading change.

To me, medical leadership is simply about ensuring that change will benefit patient care. The best way to do this is to engage and empower the people on the shop floor – the talented doctors, nurses and allied health professionals who work tirelessly for their patients. It is about winning hearts and minds.

If you want to know what is wrong with the system, go to a ward and ask any junior doctor, nurse or patient. They will tell you. These are the people who should be shaping and moulding change with senior leaders acting as enablers. If patient care is put at the centre and health care professionals are working alongside managers, then meeting targets, and making efficiencies and cost savings will follow.

It is now abundantly clear to me why doctors should be involved in health care leadership. The days when we were simply practitioners of medicine are over and we must now be equal partners in the creation and orchestration of a sustainable NHS. There is a clear need for medical leadership roles to be taken seriously, with dedicated time committed to them and not ‘squeezed’ on top of busy clinical schedules.

Is there is a role for Health Education England to develop integrated training tracks for leadership in the same way it has for academia? I believe so. The challenge will be ensuring that clinical colleagues do not view this as ‘management’ training and that they welcome this new breed of medical leaders.


Jeremy Butler

Public Governor,
Royal Berkshire NHS Foundation Trust
Comment date
29 January 2016
Congratulations on your efforts. The roles of Manager and doctor are very different but we definitely need doctors to step up to the plate in senior management roles. This needs management training; doctors are highly intelligent so should lap up new knowledge and skills. Of course many doctors (perhaps most) wish to remain clinically centred and this must to be respected.

Adrian Hayter

Clinical Chair,
Windsor Ascot and Maidenhead CCG
Comment date
31 January 2016
Agree that as clinicians we must step up and lead our local communities. The hierarchical nature of the NHS has failed to deliver check out insightful article from 2012 by Ciaran Devane. http://www.nhsconfed.org/~/media/Confederation/Files/Publications/Documents/leadership-matrix.pdf
He describes new leadership arrangements in the NHS.

Pearl Baker

Independent Mental Health Advocate and Advisor/Carer,
Comment date
01 February 2016
It sounds an amazing opportunity the only problem is you have failed to engage any Patients, Carers, in this exercise, so I am afraid 'doomed' from the start.

Example 1.
GP confirms her LTC Mentally Ill Patient no longer requires a 'Care Plan' Why?

This question is one as a Leader to find out, Agree?

The GPs patient has no 'patient centred choice of who their 'Health & Social Care' provider can be? Agree?

Need to look into this. Agree?

Carers are often denied access to GP requiring their concerns re 'Safeguarding'?

Need to look into, Agree?

GP fail to know or understand their LTC Mentally Ill Patient is entitled to PB. Agree?

Need to look into why the GP is NOT better informed on their patients rights. Agree.

GPs need to understand information on their patients right under the Care Act 2014 Human Rights Acts comes under their 'umbrella' do you agree?

Clinicians role has expanded, unfortunately the training they receive is insufficient, taking into account the LEGAL factors, Human Rights Act, 'Safeguarding' and to recognise the Carer's role is now acknowledged in LAW. and much more.

The above is a fact of life, do you agree?

To be a 'good' clinician you have to think beyond the 'box' and that is the problem. Do you agree?

The above has to be addressed. Do you agree?

The final question is this? how can a Clinician 'right off their vulnerable patient' without having all their health and social care needs in front of them? do you agree?

Action. INTEGRATION including the CARER

Do you agree?

I would also suggest the CQC are also involved in your work, and of course the 'MONITOR' who may turn out to be one of the problem? as the BANKER

Alistair Hellewell

Consultant Anaesthetist,
RD&E NHS F Trust
Comment date
06 February 2016
A really good piece, thank you. I think we need a number of things to be clear in people's minds in order that we can successfully rethink the way we deliver healthcare.

1. The difference between leadership and management. The NHS is awash with management but lacking in true leadership. Management should enable and facilitate the deliver of the vision as outlined by the leaders.

2. We are all on the same team and the patient should be the sole focus of our enegies so we can deliver safe effective care each and every time. There is too much complexity and consequent opacity in the 'system'. This leads to the need for greater levels of management and further complexity and opacity. Thus feeds into point 3 below.

3. The command and control management that is pervasive in the current NHS stifles creativity and innovation as those who command and control cannot accept the premise that those who do the work at the coalface know how to most effectively deliver the safe, timely healthcare we should.

4. There is a difference between quality improvement and innovation. We should strive to constantly improve what we do, this is QI, but we should also look to innovate the way we deliver care. Innovation is a truly new way of thinking and/or doing something and is very distinct from QI.

In the 21st century we truly need to think differently about the way we deliver safe and effective healthcare.


Dr Julie Barker

GP, EOL Lead, Macmillan GP,
Newark & Sherwood CCG
Comment date
06 February 2016
Thank you Binita. You have inspired me to continue to seek to improve my leadership skills and 'step up to the plate' as Alistair says.

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