Managers need to be less 'cliquey' if they are to attract clinicians to the top roles, the president of the Royal College of Physicians has warned.

Professor Ian Gilmore has spoken out amid fears that the voice of the medical profession is being suppressed by a lack of leadership and too few doctors applying for senior trust positions.

He told HSJ: 'It's cliquey at the top of trusts and it's not easy for doctors to come forward. Career managers who have been brought up together have a certain ethos and it's not easy to step up and leapfrog them to a chief executive position.'

He called for trusts to be headed jointly by a clinician and a manager, with the clinician taking on a much bigger external role than currently expected of medical directors.

He hit back at claims that doctors have been too self-interested to make a helpful contribution to national policy.

Last month's report by Sir John Tooke's inquiry into Modernising Medical Careers accused professional bodies of promoting the interests of their members rather than patients, and failing to speak with a united voice.

Medical bodies have come under further attack this month in an article in the Journal of the Royal Society of Medicine by Dr Richard Smith, executive director of UnitedHealth Europe and a former editor of the British Medical Journal.

Dr Smith told HSJ: 'There's a cacophony of different voices instead of one clear, well-informed, strategic voice. If the government doesn't like what one group has said it just goes to another group.'

But Professor Gilmore said: 'It's not surprising we don't always speak with one voice, because we're senior people with our own ideas about the way things should be done.

'Leadership isn't about standing on a soapbox and shouting at government that they have got it wrong, it's about bringing about change effectively - saying there's a dearth of leadership is far too simplistic.'