Engaging the trainee medical workforce in management roles represents a significant challenge, yet one that is essential to the future of the NHS. By Tim Robbins and colleagues
Junior doctors represent the lifeblood of the future NHS. They hold enormous potential to develop as healthcare leaders.
Declining morale and recent contract disputes jeopardise the motivation of trainees to develop the skills and experiences they need to lead world class services. There is an urgent need to re-engage trainees, supporting them to work directly with healthcare managers and leaders, in itself boosting morale, understanding of systems and policies, and delivering real gains to current and future patients.
The Department of Health has identified “deep-seated issues relating to junior doctors’ morale, wellbeing and quality of life”
The Department of Health has identified “deep-seated issues relating to junior doctors’ morale, wellbeing and quality of life”. This has been compounded by recent contract disputes, with trainees left feeling disengaged from the healthcare service within which they work.
A “junior doctor” social media Facebook page of 62,700 members repeatedly highlights their mistrust of NHS management structures. Junior doctors’ conferences that previously focused on improving training and models of patient care, are now dominated by discussions around contracts and working conditions.
A failure to re-engage and motivate junior doctors would leave a training generation disaffected and underequipped to lead and manage the future NHS.
The contract dispute, albeit in an undesired fashion, has demonstrated the enormous energy, organisational and leadership abilities possessed by the trainee workforce. Grassroot marches of over 2,000 people through central London, national meet-the-doctor events and substantial fundraising efforts all represent significant organisational feats achieved by trainees – often independently from union support.
Capturing such passion and applying it to the delivery of world class patient services represents an enormous opportunity to any healthcare organisation.
At University Hospitals Coventry and Warwickshire Trust, a major tertiary referral centre in the West Midlands, junior doctors have been supported to engage directly with senior trust-wide management committees. In contrast to other national examples, where trainees often sit simply as observers, trainees in this trust are full members of each committee.
They are supported through the committee chair to take an active role not only in meetings, but also the actions and work streams created. A parallel trainee leadership group provides the opportunity for peer support and collaborative working amongst motivated trainees.
This approach has been inspiring to trainees, with significant over-subscription requiring expansion of the programme. A total of 25 junior doctors are currently participating, each allocated to a diverse range of committees, including patient safety, education & training, risk, infection control and digital health.
At UHCW, we run in parallel, a cross-speciality “Practical Leadership & Management for Registrars” programme, every six months, a cohort of 20 registrars have three days of interactive training – “Your Leadership Behaviour, Transforming NHS Services, and Governance – the Pursuit of Excellence.” This is provided in partnership by our experienced consultant body, management team and our local clinical commissioning group.
The work has stimulated varied projects, including improving handover, ICT training and seven day service provision
Registrars embed classroom learning by leading a quality improvement project, attending business case presentations, shadowing chief officers, clinical directors and managers. Regular feedback comments include “passionate and inspiring, insightful, having a vision and working towards it.”
Trainee feedback has been very positive, in particular trainees express surprise at the extent to which senior managers are prepared to seek out and listen to their views. The work has stimulated varied projects, including improving handover, ICT training and seven day service provision.
The most motivated trainees have gone on to pursue Master’s level modules in leadership and management at Warwick Medical School, and won a diverse range of national fellowships and awards, including a National Medical Director’s Clinical Fellowship and Winston Churchill Memorial Trust Fellowship. With 64 per cent of participants being female, our programme highlights the potential benefit of inspiring trainees early in order to meet the NHS Confederation’s aim to achieve fairer representation of women in leadership roles.
It is essential that trainees who engage with management challenges at an early stage of their career are able to seamlessly build on such skills as they progress. Our programme has links for those who wish to be enrolled in a Masters in Healthcare Operational Management at Warwick University.
Engaging the trainee medical workforce in management roles represents a significant challenge, yet one essential to the future of the NHS. Interventions such as the trainee leadership group described here offer a crucial first step for both trusts and their trainees.
Developing such programmes regionally and nationally will offer trainees the opportunity to experience a varied portfolio of roles as they rotate between NHS trusts.
Dr Tim Robbins is NIHR academic clinical fellow, Dr Clare Ingram is consultant anaesthetist and Professor Meghana Pandit is chief medical officer and deputy chief executive officer at University Hospitals Coventry and Warwickshire Trust
Acknowledgements: Dr Maggie Allen, Dr Shirish Dubey and all clinical & non-clinical senior managers, and leaders at UHCW.