As a military medical officer working in the NHS and a Health Foundation Leadership Fellow, my professional development has been different from that of most clinicians in the UK, writes Ed Nicol
The potential for individual leadership is a key foundation of the military’s recruitment strategy. There are a number of benefits to training in such an environment, which the wider NHS may wish to consider when seeking to create better clinical leaders.
All military doctors complete their foundation training in the NHS but, unlike their civilian colleagues, they then spend several months in initial officer training. The importance of this time cannot be underestimated. It is spent learning about the wider organisation and I believe it is critical in forging both corporate understanding and an appreciation of the wider organisational picture
This early organisational teaching and awareness underpins future leadership at local and national levels. In contrast, the current structure of medical training in the NHS, whether undergraduate or postgraduate, makes almost no reference to the wider profession. It fails to address the history, structure or challenges of the organisation and place these in the service’s political context. It is a far greater challenge to expect someone to be a natural leader when their experience is based solely on clinical competence.
Initial officer training is followed immediately by a tour of duty in primary care attached to a ship, regiment or flying station. This is regardless of chosen professional career path. As a junior medical officer, clinical and management leadership challenges are almost daily occurrences, and are often performed in an operational military environment.
Clinicians’ wider role
This is a challenging environment for a junior doctor, but full support and line management are provided by a senior independent practitioner. It is also a time when medical officers realise they have both a clinical role and a wider responsibility to the organisation and its mission. As an adviser to a military commander, it is important to balance your own agenda within a wider (and often conflicting) context. This, I would argue, is not that different to the role of a doctor having to work in a strategic management position in a trust or primary care trust.
The tour of duty develops confidence in decision making and negotiation skills. On completion of this initial phase of a military medical career, doctors return to their chosen specialty and, like their civilian counterparts, complete their professional exams, but often with a wealth of “softer” skills.
Alongside this practical training, however, the military has formal “staff and command” training: essentially military management training that runs parallel to clinical training. This includes wider consideration of defence policy, as well as many aspects of personnel management, human resources and finance that attract civilian accreditation through the Chartered Management Institute. Each level of residential training enables participants to work towards both the certificate and executive diploma in management and membership of the Chartered Management Institute.
The leadership qualities needed in the military and NHS are similar, although it could be argued that greater negotiation skills may be required in the less hierarchical NHS. The main difference is that at an early stage a military trainee has already been trained in broader management skills and given an insight into the wider organisation, possibly giving them more confidence to get involved, even if their ideas are not always accepted.
There are clearly many exceptional NHS medical trainees who have leadership potential, but this is not currently nurtured through formal training. However, if we wish to broaden the skills of our wider medical workforce we would benefit from more formal and embedded managerial, organisational and leadership training for our medical workforce starting in undergraduate training and continuing through basic and higher specialist training. For those who excel or have a special interest in this area, I believe we should invest in a new specialty training pathway supported by all the Royal Colleges to train our future health leaders and equip them with the clinical, managerial, organisational and increasingly business skills they will require to steer the NHS through another 60 years of change.
The views and opinions expressed in this article are mine alone and do not necessarily represent those of HMG, the MOD, the RAF or any government agency. They reflect on whether there may be anything from within my own career that has been of benefit to me as an RAF medical officer and as an aspirant future health leader in the NHS.