When I was a GP I was always amazed at the degree to which people remembered and actually acted upon my advice. Frequently the advice sought was not obviously related to any of my medical training or education - it was instead based upon a sense of respect and trust in their family doctor, the independence and wisdom that people expected and wanted but could not access in other parts of their daily life.
In the past, advice was much more accessible and the average high street was cluttered with all sorts of informal advice centres - the vicar, bank manager and town clerk were all examples of accessible and ready sources of top quality views that were guaranteed to settle most disputes and concerns. Times have changed. For most people the only senior professional they regularly meet is their GP or hospital doctor. Modern high streets are now characterised by fast food outlets and shops selling best value ways to lead sedentary lives.
Arguably, as local sources of professional advice become fewer, the need for it has never been greater. Current clinical leaders - many working as family practitioners - are overseeing the emerging development of a cohort of young people who, for the first time in many generations, may not live as long a life as their parents did.
Guiding the young
From the age of five to 18 most children have little or no contact with their family practice, yet these are the years that are associated with the initiation of the risks that lead to increasing obesity, less and less exercise, smoking, excess alcohol consumption, unsafe sex and recreational drug use. What clinical leadership role should modern family medicine take on if we are to challenge and reverse this lifestyle epidemic? What role do clinician's have in helping families and carers co-create good health?
Let us build upon the respect and trust that the public have in us. The unique strengths of the English list based system create a bond between local clinicians and their registered population. As they achieve foundation status, nearly all hospitals situated within challenging urban communities need to establish a clearer local community leadership role. People look to their doctors and nurses to lead change. Modern medical practice must move beyond the confines of the ward or waiting room and create a dialogue that people hear not just within the consulting room walls but also across whole communities, challenging the inexorable slide to more adverse lifestyle risks. The modern clinical leader should be concerned with raising local whole community aspirations for change and better health.
Straddling boundaries
This means working as clinical leaders across public service boundaries. Investment in better health comes from across health and local authority boundaries. We need to join forces with our local authority leaders and become the visible senior influencers who lead by and through example. Senior clinicians should work within a dynamic tension with local citizens - creating a dialogue that balances people's rights to lead the lives they want with the challenge of these choices affecting others and, critically, affecting the healthcare resources available to all.
Some of our greatest health reformers and leaders recognised that at times of challenge and change people expected senior professional voices and representatives to help secure the changes that help the majority achieve better health. Instead of monitoring and managing people's long-term conditions, should we not be working to prevent them? Instead of charging a local school or parent for a child's medical report, we should be freely breaking down the boundaries that help us work together to prevent the need for the report in the first place.
Accepting the challenge
The great challenge clinical leaders must now address is how we step up to the plate and recognise that, as respected and listened to local professionals, we have a major leadership role to play. This is a role to advocate and ensure that the most vulnerable in society grow up healthier than they can expect to do so today. It will require a more visible form of clinical leader, trained and equipped to influence and work through others.
Current leaders cannot wait to acquire these skills. Post holders in both traditional leadership roles and through many of the new clinical leadership roles that hospitals, primary care trusts and practice based commissioning groups are establishing, need to rapidly engage with people across communities and create a new movement for better health. If we look to be leaders solely with our organisation, we will be letting down those across our communities who still hold us in such high esteem - and critically are still very likely to listen and act upon our advice.
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