Lord Darzi's review puts forward bold plans for increasing clinical leadership in the NHS. Clinicians must step up to the challenge if their influence and expertise are not to be wasted, writes Susan Shepherd

Under the heading "enhancing professionalism", Lord Darzi's report High Quality Care for All says the NHS will invest in clinical and board leadership, with clinicians encouraged to be practitioners, partners and leaders in the service.

An examination of medical professionalism and its underpinning values was at the heart of the 2005 Royal College of Physicians report Doctors in Society: medical professionalism in a changing world, a report that not only set the gold standard for medical professionalism but which also provided the impetus for a series of national consultations (road shows) designed to look in greater detail at some of the immutable elements of medical professionalism in practice.

The product of the road shows was the joint Royal College of Physicians and King's Fund report Understanding Doctors: harnessing professionalism, which includes comments from nearly 800 doctors, medical students and others about medical leadership and the closely associated issue of professional management.

Confused picture

At the road shows, dialogue on leadership was heavily weighted towards the perceived shortcomings of medical leadership on the national stage. The leadership of national medical institutions and organisations was seen as confused, with too many fingers in the leadership pie to enable doctors to exploit fully opportunities to influence national policy.

However, in Lord Darzi's report, leadership is emphasised as a mechanism for effecting change and enhancing quality - with opportunities for this more likely to arise for doctors at a local than a national level. In the words of Lord Darzi: "[It] requires a new obligation to step up, work with other leaders, both clinical and managerial, and change the system where it would benefit patients."

So are doctors up to this task? Road show participants regarded leadership as a vital tool in strengthening professionalism. Professionalism has many benefits: a constant drive towards improvement, excellence in practice and working in partnership with members of the wider healthcare team. What was also evident from the road shows was the need to appreciate the demands and complexities of leadership, including at a local level, where leadership often blends uncomfortably and imperceptibly with management - a thorny topic for doctors.

Support system

That doctors will become increasingly involved in the development and management of services for patients has been widely anticipated. Drawing on road show responses, it is clear that there is considerable support for the principle of doctors taking responsibility for leading and managing the health system. However, if doctors are to become more involved in management, they will require support - through training and development opportunities and from their peers - all issues the RCP is engaged with in its Masters in Medical Leadership programme.

Fundamental to the success of these and other initiatives is a cultural shift. Too often, formal involvement in management by doctors is seen by their colleagues as crossing to the "dark side" - an illogical position when so much criticism in the past has been directed at poor or inadequate clinical engagement. Combining clinical and management responsibilities effectively will be a difficult trick, but one the medical profession must not back down from if its legitimate influence and undoubted expertise are not to be wasted.

In the words of one road show participant: "We gave away medical leadership when Griffiths came in - we said 'we are going to have all these managers, we will just ignore them and put our heads down and do clinical medicine'. How stupid we were."