‘Going over to the dark side’: creating a culture of clinical leadership in the NHS

Over the last year, I’ve heard the phrase ‘going over to the dark side’ more times than I care to admit. No, I haven’t been auditioning for a role in the latest Star Wars film, I’ve been spending my time on various wards in and around Cambridgeshire, during the first clinical year of my medical degree. Here, on the shopfloor of the NHS, this phrase is used when clinicians take positions in hospital management, reflecting deep-rooted prejudice against the non-patient-facing roles within our healthcare system. 

As clinicians, we too often perceive management and policy as being less important than prescriptions and procedures. I frequently hear from colleagues about how the NHS is bloated with overpaid bureaucrats, despite the NHS being one of the least managed healthcare systems in the world. In reality, effective leadership is probably the most important factor in improving outcomes for patients.

We are taught to look up to swashbuckling professors of surgery, but hear nothing of doctors who go on to become medical directors and chief executives

The problem starts on day one. Medical schools, especially the established ones, are supremely focused on biomedical science (although some are better at including leadership than others). We learn the enzymes that comprise the Krebs cycle, but not what an integrated care system is. We are taught to look up to swashbuckling professors of surgery, but hear nothing of doctors who go on to become medical directors and chief executives. To aspire to general practice as I do - a specialty traditionally associated with clinical management – is considered unambitious.

The problem continues when we graduate from medical school and begin our career as doctors. Specialty training programs devote very little time to leadership, and there is no training at all in the hard skills required for modern management, such as an understanding of finance and human resources. The normal route into clinical management – namely becoming a medical director – is not a defined career choice. Rather, it is something doctors stumble into having completed their training in other areas.

The current system both ill-prepares doctors … for management and does not encourage our best and brightest to aspire to leadership positions in the first place

This prejudice and corresponding lack of training is even more surprising when you consider that one-in-five managers within the NHS are doctors. The current system both ill-prepares doctors, who do go into management, for management, and does not encourage our best and brightest to aspire to leadership positions in the first place.

Over the last few weeks, I’ve been undertaking a placement at the NHS Confederation as part of my medical degree. This has inspired and educated me in equal measure. Working on integrated care, for example, I’ve learned about how hospitals are forming partnerships with community organisations to support patients through the cost-of-living crisis. This will have an immediate impact on my clinical practice, as I will work with charities and social care providers when discharging patients, to ensure they do not return to the same cold home that originally caused their illness.

Policy and management placements need to be an integral part of the medical curriculum

Policy and management placements, like this, need to be an integral part of the medical curriculum. And not just in national bodies like the NHS Confederation; a society I founded at my medical school is coordinating placements within the executive leadership team at our teaching hospital. Furthermore, specialty training programs need to have management embedded in them. An interesting idea would be for trainees to spend four days a week working clinically, and then one day a week working within hospital leadership.

One of the best resources available to the NHS is the thousands of bright, ambitious, innovative clinicians who deliver care to our patients. To take advantage of this resource, we need more clinicians in management roles, and we need to properly prepare clinicians for management during their training. This will require a cultural shift towards clinical leadership, spearheaded by our medical education system.

Harry Dunn is a medical student at the University of Cambridge and was a policy intern at the NHS Confederation from May to June 2023.

You can follow Harry on LinkedIn