The revolution in access to cardiac surgery that Devi Shetty has facilitated in India shows what is possible through clinical leadership.

Surgical economies of scale in this example would be hard to achieve here given UK patient population numbers, but the principles of increased efficiency through better service design, planning, continuity of care, and integration between primary and secondary care are highly relevant and being taken forward by UK surgeons.

Evidence gathered from enhanced recovery project pilots shows quality of care remains high and bed days are reduced. Clinician leadership in this example has been the key driver; surgeons championed clinical and other patient benefits to gain team and managerial support to make changes required to team working, ward facilities and patient education.

Surgical research is another area crucial to driving change and improving efficiency and quality of care. It provides the foundation for groundbreaking new treatments, devices and surgical techniques.

There are obstacles to these initiatives, however. Chief among these is the lack of a clear mechanism for the spread of best practice and evidenced based innovation in the NHS, but short termism versus utilising long term investing principles to increase efficiency also feature.

Other problematic areas include data availability and quality in order to build an evidence base. Clinicians have a particular leadership role in this area through auditing. This increasingly important powerful tool has been championed by the surgical profession for some time, but it does require investment.

The new commissioning structures will be the key to delivering these changes so we must ensure clinicians are core to these arrangements. Clinicians must be able to deliver the professional guidance and standards to underpin the commissioning of services that patients want and need.