There is vast leadership potential in the junior doctor workforce, as Fiona Pathiraja and Kate Drysdale explain

David Nicholson’s aspiration that the NHS should have “a doctor applying for every chief executive post advertised” is yet to become a reality.

The report on medical chief executives’ career progress, commissioned by the NHS Institute for Innovation and Improvement and the Academy of Medical Royal Colleges, reminds us that doctors are under-represented at the executive management level. 

It highlights pay differentials, risks to professional identity and a lack of job security as barriers to doctors becoming chief executives in the NHS.

Across the country, over 250 junior doctors are on national or regional leadership schemes including Prepare to Lead at NHS London, the Chief Medical Officer’s Clinical Advisers Scheme and NHS North West leadership fellowships. There are hundreds more delivering tangible benefits to local health economies through quality improvement projects. 

It may well be today’s younger members of the profession who will increase the number of senior management posts filled by doctors in the future.

These junior doctors believe that doctors should be applying for chief executive posts on equal footing with their management colleagues. They understand that management, far from being an area for “keen amateurs” to try their luck, is a specialty like any other. 

This group are capitalising on their unique perspective from the front line of clinical service and actively seeking management skills and experience. 

The medical chief executives report highlights the notion of “hybrid roles” adopted by clinicians who move into management and the associated dilemmas of professional identity. Junior doctors who are involved in leadership positions are successfully managing portfolio careers and take a wider view of the role of the medical professional. Therefore, they are well positioned to address the issues.

Collective power

The NHS has long underestimated the collective power of its 55,000-strong junior doctor workforce. Enlightened chief executives are finally taking action to harness the potential of this capable and highly motivated group:

  • Robert Naylor, chief executive of University College London Hospitals Foundation Trust, has described doctors as “the greatest untapped pool of intellectual and managerial resources in the NHS”.  This realisation has led the trust to commission an introductory programme for trainees, Getting to Grips with the NHS, supplemented by a five-day leadership course for senior specialty trainees. The trust aims to equip its doctors with an understanding of leadership and management while providing a return on investment to both the trust and the wider NHS. 
  • NHS North West chief executive Mike Farrar has led the innovative concept of a healthcare Dragon’s Den, where junior doctors pitch ideas to an expert panel to secure funds to run an improvement project. The executive board’s commitment to junior doctors is such that they provided a capital investment of £50,000 and management support for developing business cases.

Clinical leadership is not merely a buzzword, but a real force for change. Atul Gawande, whose name is synonymous with clinical leadership in the United States, was included in this year’s Time 100 list of most influential people worldwide.  Harnessing the potential of the dedicated junior doctor workforce is essential if the NHS is to embed clinical leadership in the future of the service.

Portfolio careers that allow doctors to maintain elements of clinical practice while undertaking roles in management and leadership need to become mainstream. It is crucial that clinical leadership should not be an adjunct to a clinical career but an integral part of it. 

This requires strategic workforce planning between deaneries and employers to facilitate flexible training and job sharing. Senior managers should take an active role in talent spotting junior doctors with leadership potential.

Harnessing the intellectual power of this group and supporting their development can deliver significant improvements and cost savings for organisations.

It is well known that junior doctors are influenced by the consultants they encounter early in their careers. Doctors wishing to pursue leadership roles often struggle to find appropriate role models. Organisations should prioritise identification of suitable role models and encourage networking between junior doctors and senior medical managers as part of succession planning.

There is a quiet but steady revolution under way in the UK with a dedicated group of junior doctors as first followers. This valuable resource can no longer be left unexploited.

Healthcare in the UK cannot afford to wait for a culture of clinical leadership to evolve organically. We need to make a concerted effort to reach the tipping point sooner if we are to achieve improved quality and productivity.

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