Considering how many talented clinicians there are in the NHS leadership ranks, relatively few actually make the transition from local clinical leadership roles to senior system-wide or executive positions.

But why is this? First, senior team leaders and chief executives need very different skills and aptitudes. In an increasingly complex health system, senior managers are more likely to seek new ideas from the Harvard Business Review than from traditional professional journals. A one-week management course for senior clinicians is no longer enough to equip aspirant clinical managers with the skills they need to develop a mixed portfolio career. Much more useful is a part-time MSc or MBA from a respected business school. The NHS next stage review recognises this shift and seeks to invest in and develop a new cohort of clinical leaders and managers.

Second, we do not make it easy for clinical colleagues as they move towards the so-called "dark side" of management, going from being respected clinical peers to senior executives. Balancing a mixed portfolio career and being good at more than just your professional craft is hard work. As well as learning new skills and approaches, many clinicians try too hard to maintain clinical respect among those they are being asked to manage. Too many former colleagues expect them to somehow maintain their original skill levels and availability for emergency work.

Too frequently, clinical staff fail to recognise the demands this places on their leaders and resentment builds. The new manager-clinicians set themselves unrealistic expectations and try and keep their service commitment steady. Significant tensions arise between the leader and those they now lead.

Cultural shift

However, many well-supported clinical units manage this change with ease. When I am in the US, I am impressed by how the major medical groups segment their clinical workforce in the early stages of their careers, recognising and investing in those who will become great service chiefs and in those who are potential chief executives.

In these organisations, if a colleague gives up clinical practice to take on a senior role or a leadership position, there is not an insistence that they maintain a mixed portfolio of parallel clinical commitments to remain credible with other clinicians. Instead, there is pride that senior leaders who trained and grew in the clinical fraternity have moved on to a different realm of influence. Others have confidence that they will work hard to create the conditions that allow those still practising to do their jobs effectively.

Senior management roles are challenging and exciting. We want the very best people in the NHS workforce to earn and hold them. It is important that we support those who aspire to these positions by allowing them to have time away from the "day job" to get the skills they need. In some cases, this will mean a managed transition away from all clinical responsibilities. A growing cohort of leaders who were formerly clinicians, working alongside those supported to hold mixed portfolio careers, is the best way to secure the operational environment that delivers improved clinical outcomes - a win-win for all. Our challenge is to recognise this and support those willing to take it on.