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Guest authors bring different perspectives and diverse voices to our blog. They do not always represent the views of The King’s Fund.


Developing clinical leaders through innovation


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    Dan Leveson

In 2016, I read about the leadership development opportunities offered by shadow boards. Shadow boards offer staff members the opportunity to work with senior leaders on strategic projects and gain an understanding and knowledge of working at board level.

I wanted to create something similar with trainee doctors and the trainee leadership board was born. It offered a small group of next-generation clinical leaders at Oxford Health NHS Foundation Trust an opportunity to learn about leadership in the NHS, take on one of the trust’s challenges and present their solutions to the board.

Fast forward to 2021. The trainee leadership board in Oxford now has multidisciplinary membership and the idea has expanded to Buckinghamshire, where Buckinghamshire Healthcare NHS Trust has run three trainee leadership boards and in 2020 went a step further, creating a board affiliate role.

Developing clinical leaders

The board affiliate role provides a unique development opportunity for future NHS leaders. The participant has access to all the information a trust board has. They are involved in board discussions that influence the growth and strategic direction of our organisation and expected to work to the same standards as any member of our board. The difference is they bring first-hand experience of what it is like to work in our organisation.

The first board affiliate was Dr Becki Medlock, a specialist medical trainee from the first cohort of Buckinghamshire’s trainee leadership board, who began her role in February 2020. Becki worked one day a week as board affiliate and participated in monthly board and finance and business performance committee meetings. Becki also oversaw the trainee leadership board and the improvement project it worked on.

Feedback about the board affiliate role has been positive. Clinical staff feel more engaged and represented. Becki understood what it is like working in clinical teams and offered an alternative communication route between ward and board. Board members noted a change in meeting dynamics just by having a different perspective at the table. Having a clinician on the board also enabled the voices of our workforce to be heard. This has been invaluable during the Covid-19 pandemic, bringing things to our attention that we may have missed and enabling us to gain a better understanding of the concerns or challenges facing sections of our workforce.

We have learnt a lot from Becki. She has brought diversity of experience and perception of the trust to us. She brought things to our attention that we otherwise might have missed. She has been great at challenging our knowledge, experience and decision-making.

Hattie Llewelyn-Davies, Chair, Buckinghamshire NHS Trust

For Becki herself, the board affiliate role offered ‘hands-on’ experiential learning that enabled her to discover and refine skills, make decisions, address challenges and interact with influential colleagues – key skills for developing clinical leaders. It also offered an insight into NHS leadership and management that very few patient-facing health care workers get.

I feel incredibly privileged to have had this role. I have gained knowledge about how the NHS is led and managed providing a great foundation for my future career. I cannot recommend enough integrating more experiential learning opportunities into clinical training and education. I hope other NHS organisations read this, see the wider benefits and consider similar initiatives.

Dr Becki Medlock

Looking ahead

In 2021, there will be two board affiliates, giving the trust the opportunity to make the programme more inclusive and appoint a member of our clinical workforce who is not a doctor. We piloted a new recruitment process for these roles: no CVs or cover letters were needed to apply; we used scenario-based questions instead of application forms; and carried out blind shortlisting and structured values-based interviews. We tried to remove bias from our recruitment process by focusing on competencies and values regardless of experiences or job titles.

In addition to a trainee doctor, we have appointed a community physiotherapist, Sandra Silva, bringing another new perspective to our board. This is exciting but might bring new challenges. Trainee doctors have fewer ties to an organisation than a permanent member of our clinical workforce. It is vital we overcome this and maintain an open and honest environment that encourages the board affiliate to represent different views.

The development of these programmes has been driven by a desire, both personal and organisational, to value difference. Embracing different experiences, thoughts and opinions at every level of our organisation will help us develop a more compassionate, inclusive and open culture. Changing cultures is difficult and requires time and patience to challenge the symbols and stories and customs and practices that have been built up over many years and can act as barriers to change. It will be a long journey, with a great deal to learn, but I believe encouraging fresh eyes and ideas to find solutions to some of the NHS’s longstanding problems will contribute to a more sustainable future.

I would like to thank following for their support and contributions to the trainee leadership board and board affiliate programmes.

From Buckinghamshire NHS Trust: Hattie Llewelyn-Davies, Neil Macdonald, Dr Becki Medlock, Dr Marc Davison, Carley Brown; and from Oxford Health NHS Foundation Trust, Stuart Bell CBE, Dr Joe Clacey and Dr Gerti Stegen.


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