{"id":1251,"date":"2026-08-17T07:00:21","date_gmt":"2026-08-17T07:00:21","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjleader\/?p=1251"},"modified":"2026-08-12T11:00:27","modified_gmt":"2026-08-12T11:00:27","slug":"ending-with-the-beginning-in-mind-reflections-from-the-fmlm-national-medical-directors-clinical-fellowship-by-lynda-odoh","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjleader\/2026\/08\/17\/ending-with-the-beginning-in-mind-reflections-from-the-fmlm-national-medical-directors-clinical-fellowship-by-lynda-odoh\/","title":{"rendered":"Ending with the Beginning in Mind: Reflections from the FMLM National Medical Director’s Clinical Fellowship. By Lynda Odoh"},"content":{"rendered":"

My favourite part of a run is not the run itself.<\/span><\/p>\n

It is the moment I stop my watch.<\/span><\/p>\n

The moment I look back.<\/span><\/p>\n

How many miles did I cover?<\/span><\/p>\n

Where did I find my rhythm?<\/span><\/p>\n

Where did I slow down?<\/span><\/p>\n

How does today compare with yesterday?<\/span><\/p>\n

Last week?<\/span><\/p>\n

Last month?<\/span><\/p>\n

There is something deeply rewarding about seeing progress that was invisible while I was moving. It is the gift of time and of distance covered the rare privilege of looking backwards and noticing the patterns. To see the moments that quietly changed your direction, the conversations that shaped your thinking, and the steps that stretched you further than you realised.<\/span><\/p>\n

Without that pause, we risk starting the next run without fully appreciating the progress already made.<\/span><\/p>\n

Eleven months ago, I stepped into the Faculty of Medical Leadership and Management (FMLM) National Medical Director\u2019s Clinical Fellowship with curiosity. Having led pilots and innovations in varied capacities, I wanted the bird\u2019s-eye view of leadership at scale in the NHS – to understand how good ideas spread, how variation can be reduced, and how health systems move towards more equitable, value-based care.<\/span><\/p>\n

What I did not fully anticipate was this: scale magnifies everything.<\/span><\/p>\n

It magnifies vision.<\/span><\/p>\n

It magnifies possibility.<\/span><\/p>\n

It magnifies momentum.<\/span><\/p>\n

But it also magnifies complexity.<\/span><\/p>\n

Ambiguity.<\/span><\/p>\n

Uncertainty.<\/span><\/p>\n

It could feel less like steering a ship and more like a calm, calculated sailor navigating\u00a0 the thousands of waves that make up an entire tide.<\/span><\/p>\n

From co-leading the development of the national template service specification for integrated ME\/CFS and Long COVID services, to initiating and leading the National Quality Capability work for GPs of the Future, supporting the implementation of the Red Tape Challenge,\u00a0 providing clinical advisory to the National Neighbourhood Health Readiness Programme in the North West of England and leading the design of the first rapid systems thinking hackathon that generated use cases for National NHSE\/ NICE health technology prioritisation process, I realised the answers I had been searching for were rarely found in the workstreams themselves.<\/span><\/p>\n

They were found in the habits that each opportunity kept demanding of me.<\/span><\/p>\n

Curiosity had already brought me to this fellowship but the fellowship gave me four more habits that I hope will stay with me for the rest of my career but also worth a reflection for the leader in you (formal or informal roles included).<\/span><\/p>\n

Capability<\/strong><\/p>\n

Just like a clinical career, capability is refined on the shop floor in guided exposure, but also in the deep end. It was showing up, contributing to conversations, adding value, having mentors who stretched me while holding the safety net, and building trust that I could be relied upon.<\/span><\/p>\n

These projects mattered less for the outputs themselves than for what they created in me: belief, credibility and confidence. In others: becoming someone others trust to move work forward, working with others and aligned with priorities.<\/span><\/p>\n

Connection<\/strong><\/p>\n

I expected networking to be about volume. Instead, it became an increasing act of generosity, adding value before asking for it, building trust before needing it, nurturing ways for conversations to continue long after meetings had ended. Interestingly some of the most meaningful progress came through revisiting conversations that had not landed the first time, listening carefully and following up.<\/span><\/p>\n

Working remotely for much of the fellowship also challenged one of my assumptions. I had worried that distance would limit relationship building but I also learned that meaningful connection could be built through intentionality to trump geography.<\/span><\/p>\n

Courage<\/strong><\/p>\n

Courage was learning that the first question should not always be <\/span>\u201cwhat is possible within today\u2019s constraints?\u201d<\/span><\/i> but <\/span>\u201cwhat would we design if we started with what truly matters?\u201d.<\/span><\/i> If constraints define the vision too early, important parts of the solution risk being lost before they are ever considered.<\/span><\/p>\n

Equally, ambition without a bridge simply becomes aspiration. People need to see how today’s reality connects to tomorrow’s possibility. Maturity thinking understanding the progression between where we are and where we want to be turns vision into action and makes implementation tangible rather than abstract.<\/span><\/p>\n

Leadership, I learnt, is not choosing between ambition and pragmatism. It is knowing which comes first.<\/span><\/p>\n

Compassion<\/strong><\/p>\n

The very thing that first called me to become a doctor turned out to be just as important when leading change.<\/span><\/p>\n

Listening deeply.<\/span><\/p>\n

Creating space for different perspectives.<\/span><\/p>\n

Ensuring every voice is heard. Value the opinion carried by the voice enough to utilise it.<\/span><\/p>\n

Maintaining humble curiousity.<\/span><\/p>\n

Paying attention to what is left unsaid and removing barriers.<\/span><\/p>\n

Whether in a consulting room or a national programme, I found that the heart of every system is still people.<\/span><\/p>\n

Ending with the beginning in mind<\/strong><\/p>\n

Looking back, I realise I began this fellowship with the end in mind.<\/span><\/p>\n

As it ends, I find myself ending with the beginning in mind.<\/span><\/p>\n

Some assumptions were confirmed, new perspectives emerged and people made it special.<\/span><\/p>\n

These perspectives and people are my greatest gift of this fellowship.<\/span><\/p>\n

For the emerging leader reading this, I hope you reflect on the habits you are already cultivating to keep bringing together people, purpose and possibility for more equitable health systems.<\/span><\/p>\n

Author<\/strong><\/p>\n

Lynda Odoh<\/strong><\/p>\n

\"\"<\/p>\n

Dr Lynda Odoh is a doctor driven by a simple mission: to make healthcare more equitable by helping the people closest to patients become better equipped to improve the systems they work in.<\/span><\/i><\/p>\n

She is currently a GP Registrar and FMLM National Medical Director’s Clinical Fellow at NHS England, where she works on national primary care policy implementation in collaboration with the Department of Health and Social Care, coordinates frontline GP leader engagement for national priorities, supports improvements across the primary-secondary care interface and contributes to developing quality improvement capability for the future GP workforce.<\/span><\/i><\/p>\n

Lynda holds an MPH in Implementation Science (Distinction) from the University of Manchester as a Commonwealth Scholar and Dick Heller Awardee, and has co-authored work on implementing digital health interventions in low- and middle-income countries.<\/span><\/i><\/p>\n

She is an RCGP Fairer Practice Lead, active mentor with Digital Health Africa, supporting doctors across Africa in digital health innovation, implementation and systems thinking. She is also the founder of several initiatives, including QICanvas, which aims to make quality improvement methodology and systems thinking more practical and accessible at the point of need, and Healthify Africa, which is developing equitable approaches to preventing and managing non-communicable diseases through locally led improvement and innovation.<\/span><\/i><\/p>\n

In 2025, she was selected from more than 500 applicants worldwide to join Harvard Business School’s Value-Based Healthcare Delivery Programme, an experience that continues to shape her vision of building healthcare systems that are more equitable and designed around the people they serve.<\/span><\/i><\/p>\n

Declarations of Interest<\/strong>
\nNone declared.<\/p>\n","protected":false},"excerpt":{"rendered":"

My favourite part of a run is not the run itself. It is the moment I stop my watch. The moment I look back. How many miles did I cover? Where did I find my rhythm? Where did I slow down? How does today compare with yesterday? Last week? Last month? There is something deeply […]<\/p>\n

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