Regulation isn't the answer - develop leaders across the board

Sir Robert Naylor’s report and focus on clinical leadership is welcome, but it focuses too much on executive roles and misses the opportunity to recognise the distributive leadership throughout the NHS.

‘Naylor’s report focuses too much on executive roles’

There is little doubt that an increase in clinicians taking executive roles would be beneficial, and that this career option should be encouraged with the appropriate development and incentives provided. 

They are high risk, high pressured roles but so are many clinical positions, and the challenge for the NHS and organisations should be to develop the leadership and innovation throughout the clinical workforce rather than focus on the heroic leader.

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How to bring about change

The task for the NHS, set out in the NHS Five Year Forward View, is clear and well rehearsed. What is less clear is how we will implement change on a scale which has never been achieved before.  

The answers will not lie in Whitehall or in a chief executive’s office, but through the staff in the NHS. Staff must be empowered to deliver the improvements in care and efficiency that many have wanted to do for years. 

Leadership has many forms, and can be seen in every GP surgery, ward and clinic. Where organisations or departments fail it is often because that leadership has been lacking or has not been given the environment to succeed. 

‘The challenge is for all, not just those in power’

The role of government, NHS England and executive positions should be to enable the workforce to deliver better care, to make the changes needed and to develop a genuine sense of ownership in the challenges ahead. The challenge ahead is one for us all, not just those seen as being “in power”.

Clinicians want to make a difference. They experience the difficulties in providing care, the waste and inefficiency around them.

They also find it difficult sometimes to make a difference, through bureaucracy and time pressures. We need to address these issues as organisations if we are to reap the benefit of staff innovation. 

Nothing is more empowering to an individual than seeing an idea develop into reality, and it is this that often encourages staff to take on new roles and responsibilities to deliver more change.

Engagement

Clinical commissioning represents an opportunity to engage clinicians from general practice and secondary care. In Bassetlaw, for example, joint working with medical consultants delivered a new medical assessment model with improved access to diagnostics and seven day consultant cover. 

This was only possible through clinical leadership, designing services around patient care, and crucially supported by strong management. This approach, where clinicians and managers work together to plan and implement change, has to be central to the future of the NHS. 

‘Clinicians and managers must work together to plan and implement change’

Regulation and bureaucracy are unlikely to disappear from the NHS. They should not be allowed to become the focus for organisations, or suppress the innovation and leadership shown throughout the NHS. 

Regulation, as described by Monitor recently, is certainly not the answer to solving issues such as foundation trust deficits or clinical reconfiguration. Throughout the NHS we need to focus on supporting staff and trust them to deliver the changes needed. Only then will we see clinical leadership flourish.

Steve Kell is a GP, chair of Bassetlaw Clinical Commissioning Group and co-chair of NHS Clinical Commissioners