The NHS requires a national clinical leadership talent management pipeline

Today we are publishing An NHS Leadership Team for the Future. Written by a group of junior doctors and students, the report explores the potential of clinical leadership. We were inspired by the German national football team, which went from failure in 2004 to World Cup winners in 2014. Their story was a result of a concerted effort to nurture young talent within a national development programme.

In some parts of the health service, clinicians engaged in management are still viewed with suspicion or feelings of crossing over to the ‘dark side’

There is an international body of evidence indicating that effective and representative clinical leaders drive better patient care. Across the NHS, we found enthusiasm for developing clinical leaders. The existing structures, however, do this in a fragmented and disjointed fashion, with multiple national and local providers. Where leadership schemes do exist, they are hampered by a lack of follow-up opportunities for further development. This has left the NHS unable to anticipate its future clinical leaders or to match their expertise to service requirements.

In some parts of the health service, clinicians engaged in management are still viewed with suspicion or feelings of crossing over to the ‘dark side’. However, cultural change is happening, as the surge in membership to the Faculty of Medical Leadership and Management demonstrates. A new network of leadership mentors, experienced clinical leaders, working within Health Education England infrastructure akin to educational supervisors, would be useful in ensuring that aspiring leaders are supported in their clinical and leadership development.

‘There remain feelings of dismay that a clinician would give up, or reduce, clinical practice to enter management’

At present, leadership and management positions are largely reserved for senior clinicians. While we agree that clinical training is paramount, management opportunities can take various forms, beginning with medical students improving the quality of their teaching, to doctors-in-training leading quality improvement projects. The NHS requires clinical leaders at every level. There remain feelings of dismay that a clinician would give up, or reduce, clinical practice to enter management.

Our report argues that a world-class health system requires clinicians at the helm and the development of these leaders must start early in their careers. In order to produce the clinical leaders of the future, we must create a co-ordinated national talent management pipeline. The formation of NHS Improvement provides an opportunity to do this.

Protected time

The NHS has previously been able to adjust training structures to meet the needs of the wider health system. The creation of national integrated clinical academic training to support clinicians entering research is one example of this evolution. If the NHS is to flourish in the current constrained financial climate, we must change the way we deliver care.

Therefore, there is a pressing need for clinicians to take a leading role in creating new models of care and ensuring that these models meet patients’ needs. Interested clinicians should be given tailored management training in order to efficiently manage population health systems. This training could form part of a national programme, similar to existing academic pathways, with protected time to develop leadership interests.

‘However, supply chain costs and overtreatment are growing threats to the sustainability of the NHS’

There is overwhelming support among the clinical community for maintaining the current funding model of the NHS. However, supply chain costs and overtreatment are growing threats to the sustainability of the NHS. Previous efficiency drives have been met with apathy from the clinical community as they have been viewed as cost-cutting or rationing exercises. The focus must be on optimising ‘value’, which is achieving the best outcomes at the lowest cost.

A growing cadre

Understanding value in healthcare should begin at the undergraduate level. Recent publications by leading thinkers, such as Atul Gawande, have helped to focus thinking on waste in healthcare, and its detrimental effect on patient care. This exemplifies the need to put clinicians at the centre of the value agenda.

Our report argues that clinicians on the front line are best placed to decide where improvements can be made. There is a growing cadre of junior doctors who wish to lead system-wide change and they should be supported and developed. Similar potential exists among nurses, allied health professionals and expert patients. Failure to harness this enthusiasm will result in the unbounded positivity of aspiring clinical leaders turning into ingrained pessimism, and our health service will be worse for it.

Dr Na’eem Ahmed is a former clinical fellow to Professor Sir Bruce Keogh and currently a junior doctor in South London. He is a trustee at Macmillan Cancer Support and a Founder of Selfless (@DrNaeemAhmed).