Vincent Sai’s Reflections on Healthcare Systems and Leadership

With a multinational upbringing across Singapore, Australia, the US, and the UK, my leadership journey has been shaped by diverse experiences. Despite over 15 years in the NHS, I remain a student of the system—curious about the global interplay of healthcare and leadership. In the past two years, my participation in trade missions organised by Healthcare UK has deepened this curiosity, offering transformative opportunities that have profoundly influenced my leadership style.

The Power of Listening
One of the most valuable lessons I’ve learned is the importance of listening. Engaging with healthcare leaders worldwide at a senior level can often tempt one to critique or analyse through a familiar lens. However, I’ve found that embracing humility and resisting the urge to judge leads to the most rewarding insights. Healthcare systems are designed with the best intentions, shaped by resource constraints and historical contexts. No one nation holds all the answers. Effective leadership thrives on curiosity, respect, and the absence of ego.

Global Perspectives on Digital Healthcare
In the UK, digital healthcare is lauded as a cornerstone of modernisation, promising to break barriers and equalise access. Yet, this narrative isn’t universal. In many countries, policymakers grapple with starkly different decisions—choosing between fundamental needs like sanitation or food security and investments in digital infrastructure. This contrast underscores the importance of culturally and contextually sensitive solutions. Leadership in global health is not about exporting a template but collaborating to address unique challenges.

The Universal Necessity of Primary Care
Primary care is central to my belief in universal health coverage—it is the cornerstone of equitable healthcare access. Yet, its implementation varies across the globe.

In Brazil, community health workers act as critical links between the healthcare system and local populations, delivering essential care and support. However, the absence of robust data infrastructure and disease registries hinders scalability and systematic improvements. Similarly, in Vietnam, local pharmacies often serve as informal primary care providers. While trusted, these relationships lack the governance needed for managing chronic conditions, introducing risks.

Such models demonstrate the value of trust in local resources. As the UK grapples with growing inequalities, these examples challenge us to rethink how we empower patients and communities to play more active roles in their healthcare.

Harnessing Patients as Partners
Healthcare is a team sport, but too often, the patient is left out of the core team. In many parts of the world, patients and communities are active participants in their own care—sometimes by necessity. For example, advancements in genomics have given rise to “expert patients” who navigate rare diseases with minimal systemic support.

This self-reliance, born out of resource constraints, offers an untapped opportunity to address inequalities more rapidly than traditional approaches. The UK must harness this potential by integrating patients more meaningfully into the healthcare team, not as passive recipients but as active contributors.

Learning, Adapting, and Leading Without Ego
Every healthcare system has its strengths. Trusted community networks, patient-centric models, and embedded cultural practices provide lessons that the UK can learn from. Our system, designed to universalise care with governance, safety, and scalability, remains a global benchmark.

Working internationally has renewed my appreciation for the NHS and its 75-year legacy. It has also presented an exciting challenge: how do we contribute to global healthcare without imposing our solutions? True leadership in this space is about building collaborative frameworks that elevate all parties.

Global healthcare leadership isn’t about offering answers but asking the right questions, forming partnerships, and learning from one another. By embracing this ethos, we can continue advancing the principles of equity and sustainability—both at home and abroad.

Author

Vincent Sai, FCA FRCGP[Hon]

Vincent is the Group CEO and Partner of Modality Partnership, an NHS GP super-partnership delivering primary and community services to over 11 million citizens across the UK. With over 25 years of experience, Vincent has led Modality’s growth and innovation, earning recognition for his contributions to transforming primary care and fostering the next generation of healthcare leaders. As Founding Dean of Pathfinder Academy and a Visiting Associate Professor of Practice at UCL’s Global Business School for Health, he plays a key role in advancing healthcare leadership and education.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.