Medical leadership: video series

The history of medical leadership

The role of the doctor in the NHS has evolved over the past 40 years. Initially doctors were expected to do their clinical work, and the administrator or manager's role was to help doctors by providing the necessary resources. Since the 1980s some doctors have been taking a larger role in management predominantly as clinical directors responsible for their service line.

However, many frontline doctors are still not involved in leadership, and there can be a separation between doctors in formal leadership roles and those who continue to treat patients and undertake their teaching and research. This separation has contributed to a growing sense of disaffection from frontline doctors who felt uninvolved in resource allocation decisions that affected the way they provided care.

The challenges of medical leadership

A number of challenges face a doctor who choses to lead in his or her organisation. At a practical level is the challenge of reconciling caring for an individual patient and leading in a micro-system that provides care for many patients and a wider population.

This challenge is often compounded by a lack of institutional value placed on medical leadership and the fact that many doctors lack the skills and training necessary to take on a leadership role. Despite these challenges, getting doctors to lead is an essential component of running an effective health care organisation.

The origins of physician disengagement

Increasingly active management of health care organisations has led many frontline doctors to feel that the autonomy they viewed as the bedrock of professional practice was being directly challenged. Moreover, they felt that their voice was not heard during service redesigns and in plans to increase the efficiency of care delivery. National targets and the increased accountability they implied also increased doctor disaffection.