A new initiative is aiming to secure a future where medics embrace management. A sound plan or wild optimism? Louise Hunt reports

In the future, doctors and NHS managers will work in harmony. Doctors will not only fully understand the complexities of commissioning but they will also be able to design and lead service improvements - they may even become managers.

This is not a far-fetched dream, it is fast becoming a reality with the UK-wide Enhancing Engagement in Medical Leadership project, jointly developed by the NHS Institute for Innovation and Improvement and the Academy of Medical Royal Colleges.

While some doctors have always had a propensity towards leadership, the project will, for the first time, make developing management skills essential to all doctors in proving fitness to practice. This will be cemented into doctors' careers, from medical school to post-specialist registration through a three-tiered medical leadership competency framework.

Causing problems

Project leader at the NHS Institute John Clark explains how such an ambitious plan is coming to fruition. From its embryonic start 18 months ago, the project has been backed by such eminent health service figures as NHS Confederation chief executive Gill Morgan and former president of the Royal College of Physicians Dame Carol Black, now chair of the Association of Medical Research Charities, along with senior Department of Health colleagues.

'We've all been talking for some time about the need to get doctors more engaged in leadership and transforming the health service,' John says. 'In 2005, the Royal College of Physicians published a report, Doctors in Society, which has become a key document in terms of getting people's minds around the fact that doctors need to be more than clinical experts - they are teachers, researchers and managers, too.'

Much of the development process has involved consultation with the medical royal colleges and deaneries. The project team also interviewed NHS chief executives around the UK to identify the extent of doctors' engagement in management and leadership within organisations and tease out what may lead to more positive and effective ways of engaging doctors, without making them feel they are being forced into becoming managers.

'The core non-medical competencies recognise that only some doctors will want to move into an organisational role, but they are skills that all doctors need, such as self-awareness and team working.

'It's interesting that when doctors cause problems it is most often around an inability to work as a team or a lack of awareness about their behaviour. It's about trying to introducing these insights much earlier in doctors' careers,' continues John.

The competency framework sets goals for doctors to meet during undergraduate training and five years of post-specialist registration. A more advanced set of competencies will be available for doctors wishing to become managers.

At undergraduate level, medical students will be learning about the concept of professionalism and self-awareness, moving out to team working and recognising the partnership between service and patient. They will then go on to understanding the health service as a business, how to manage objectives and use resources and how doctors can improve services and become champions of innovation. For consultants, there will be an emphasis on being able to strategically drive change.

John provides an example of what might constitute an assessment at post-graduate level: 'They might be asked to develop a service improvement project where they will be expected to produce a business plan. This will require some understanding of service improvement models and resource implications and the future health needs of the patients.'

Chair of the project's steering group and president of the Royal College of Paediatricians and Child Health Patricia Hamilton believes an understanding of the commissioning process and how services interlink will make a big difference in getting over the 'them and us' attitude.

'I hope we will see a much more intelligent conversation between managers and doctors,' she says.

John thinks the project will make managers' lives much easier. 'It's pretty tough for a non-medical manager to effect change if doctors are highly resistant. Clearly if you can get doctors to better understand managerial demand and managers to better understand doctors' value sets, they stop working in opposite domains.'

But harmony is a two-way process, says John. 'Just as we're looking at encouraging doctors to attain these competencies, similarly non-medical managers need to create cultures of joint opportunities to manage and effect change.'

Leadership springboard

Managers may well get a chance to forge stronger links with medics by becoming involved in delivering the scheme. 'It would be very good for appropriately trained senior health managers to be involved in training and assessment. It would be a great opportunity for managers to get an insight into medical training issues - not all managers currently have a good understanding here. There are a lot of benefits to be had from the project.'

And, who knows, managers might find themselves working alongside those doctors who have harnessed their leadership talents. 'One of our aims is to see more doctors taking management roles,' says Patricia. 'Although the project isn't solely aimed at that, it should become a springboard for regional and national leaders. I would love to see more doctor chief executives. At the moment it is quite unusual.'

In terms of timescales, the nuts and bolts of exactly how the competency framework will be integrated into training programmes and assessed are still being worked out with the relevant parties.

It is expected that by the end of September it will be known how they will fit into the existing undergraduate curriculum. The Postgraduate Medical Education and Training Board has begun reviewing the curricula of all the 58 medical specialties and will be incorporating the management competencies as it does so and the General Medical Council will use them from the first year of revalidation. The final tweaks to the framework should be made by this autumn and it is expected the project will be up and running by March 2008.

'There will be hurdles along the way as to how competencies are assessed, but there is a high level of support and commitment for the project,' says John.