What is it really like for clinicians who become managers in the NHS? Mark Johnston and Yasmin Ahmed-Little take a closer look

Dr Mark Johnston, with a background in surgical training, last year moved to work as deputy director of the European working time directive team at NHS North West and is now a directorate manager at Blackpool Flyde and Wyre Hospitals foundation trust.

He says: “It feels like a lifetime ago that I was dressed up in the standard uniform of theatre scrubs, a silly blue hat and a face mask nicely accessorised with a full-length green gown and white Wellington boots. No, I wasn’t an extra on Gok Wan’s latest fashion TV programme, I was a surgeon. Back then, I was a registrar in urology. The decision to move away from medicine, at least temporarily, was made easy by the medical training application system, which turned so many junior doctors away from the vocation or even out of the country.

“I stumbled across an advert in the medical press. NHS Northwest was looking for a team of medical advisers to drive the implementation of the European working time directive across the region. I put in my application and managed to sail through a rigorous interview process. A few months later, I found myself as a medical adviser for Cumbria and Lancashire. Not only did this mean a trip to Next to expand on the single suit I owned, it also meant that I quickly found myself in some unusual situations. As a junior doctor, I hadn’t seen a chief executive, never mind sat and advised him/her on what needed to be done to achieve EWTD compliance.

“During that year, I had some very exciting opportunities. I had several trips to the Royal College of Surgeons that used to fill me with dread because I normally only went there for exams. On these occasions, I was entering into quite tricky negotiations to explain why engagement was the only way forward to achieve EWTD, a battle that is still ongoing. I chaired the Northwest EWTD conference, I presented on the same plenary as David Nicholson. I trained for 12 years to get to that point in my medical career and not a moment of that was wasted. Without all the transferable skills I definitely would not have made it to where I am today.

Bridge the gap

“Today I am the directorate manager for care of the elderly and specialist medicine at a foundation trust. The majority of HSJ readers will understand what this entails; the people who won’t understand it are the junior doctors. Hopefully, in our trust I have bridged that gap. It is a world away from my former life, yet from this side I get to see that we all share the same objective: to ensure our patients receive the best possible care. The techniques we employ to do this are very different. However, there is definitely mileage in working together to achieve this goal. Broadly speaking, clinicians are intelligent and usually inquisitive (because that’s what their training tells them to be) so the key to engaging them is communication and explanation. I have found that I have gained their respect early in the relationship because of my background, although that is quickly lost if communication is not maintained.

“From the perspective of other members of staff, the thing that makes a difference for them is making myself available and being visible on the wards. All of this while trying to keep up with the never-ending stream of emails and deadlines that this operational role brings. As if that weren’t enough, I have developed a real thirst for looking at my services more strategically and thinking about what developments are needed to provide our local health economy with the best service they can have within the resources available. And if you ask me would I do it all again, I’d answer yes, in a heartbeat. The notorious ‘dark side’ is not that different after all to my former life as a practising clinician, and it remains true to say the common thread that brings us all together is good patient care.”

Do clinicians see it as the dark side?

There’s no point denying it. Behind the jokes and tongue-in-cheek references there still lies a gap. Have things improved? We like to think so, but I’ve spent far too much time living in the shadow of the infamous dark side to answer that impartially. Yes, I accept I am biased, but maybe life in the shadows can provide some insight into how to help further narrow the gap.

How to bridge the gap?

Many clinicians are now treading carefully between both camps, whether as clinical managers or taking time out as fellows or clinical advisers and their experiences provide invaluable insight. Most emerge with a better understanding, more empathy and desire to work together with managers. It is, however, a two-way street.

Last year, we were fortunate to have the opportunity to speak with all new recruits to that year’s NHS management training scheme and will be doing so again later this month, on the theme of “Carry on doctors and managers”.

Such early interventions can prevent suspicion towards clinical colleagues. In a similar vein, North West Deanery is piloting a scheme in which junior doctors train alongside graduates on the NHS management training scheme, learning together and from each other, not breaking down barriers but ensuring they are never allowed to build up.

The future?

Most things in life are rarely black or white. Perhaps the answer to this issue lies in the grey shadows of the infamous dark side. The introduction of the medical leadership competency framework into the undergraduate curriculum should help blur the margins, while opportunities to undertake fellowships remain in place for the time being. We do, however, need to consider the sustainability of such vital experiences in more financially challenging times and how perhaps we could integrate such opportunities in to the day to day running of the future NHS. 


Management skills junior doctors already have

  • Communication skills
  • Presentation skills
  • People management
  • Interpersonal skills
  • Problem solving and analytical skills
  • Time management
  • Organisational skills
  • Leadership
  • Team working
  • Negotiating skills
  • Working under pressure
  • IT skills
  • Teaching experience
  • Research experience