John Clark on engaging leadership: hope for the future lies with a new breed of doctors

With a few exceptions, medical students have little, if any, training in management, leadership, and service improvement. Yet from the moment they graduate, doctors require a range of such competencies, which become more important as they progress to become consultants and general practitioners.

Early exposure to management and leadership should provide the foundation for an NHS in which doctors appreciate their responsibilities to others within the multi-professional team, the organisation, and local health community, as well as to their patients and themselves.

The joint “Enhancing Engagement in Medical Leadership” project led by the NHS Institute for Innovation and Improvement and The Academy of Medical Royal Colleges, after wide consultation, has developed a Medical Leadership Competency Framework (MLCF) that describes the key competencies required by medical students, postgraduate doctors, and those in continuing practice. The framework has been adopted by the General Medical Council (GMC) and all the Royal Colleges and is now slowly but surely influencing undergraduate and postgraduate specialty training. It has also been accepted by all clinical professions and forms the basis of the new NHS Leadership Framework.

The new Faculty of Medical Leadership and Management (FMLM) has created an opportunity to promote the advancement of medical leadership, management, and quality improvement at all stages of a doctor’s training and career. It has an important role to spread good practice and to support initiatives that will make the incorporation of the agreed competencies into curricula and experiences both stimulating and relevant.

As well as a growing recognition that junior doctors need to develop management and leadership skills, many medical students and postgraduate trainee doctors are increasingly being attracted to the study and application of service improvement methodologies. A study by Gilbert et al (2012) concluded that doctors in training have a desire and ability to contribute to improvement in the NHS but do not perceive their working environment as receptive to their skills. Junior doctors who attend leadership training reported higher levels of desire and ability to express these skills. The study suggests that junior doctors are an untapped NHS resource and that they and their organisations would benefit from more formalised provision of training in leadership.

There are already some exciting initiatives that support junior doctors to lead improvement, such as the Darzi Clinical Fellowship programme (supported by The King’s Fund) and the NHS Medical Director’s Clinical Fellows Scheme (run by the FMLM). There are also a number of regional programmes, including those led by the North West Deanery and the Kent, Surrey, and Sussex Deanery, which link doctors and managers in their development programmes.

To encourage further adoption of the medical leadership movement, it is important to share which initiatives are being incorporated into undergraduate and postgraduate training, and to analyse and assess the impact of the different approaches.

Our next leadership and management review, due on 23 May, will explore the theme of “engaging leadership.” It will examine the growing evidence that securing greater engagement of staff generally—and doctors in particular—in leadership leads to a higher quality of care and greater productivity.

We support the development of clinicians at all stages in their careers—find out more about our leadership development work.

John Clark is a senior fellow, leadership development at the King’s Fund.

This blog also appears on the King’s Fund website at