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In control

In control
24 September 2012

Qualifying as a GP and then finding myself as a partner in a large semi urban practice, has brought with it many challenges.

Lots of newly qualified doctors will appreciate that when entering the working environment, it is difficult enough to get to grips with the workings and continuous changes in primary care, before even thinking of yourself as a future leader.

Qualifying as a GP and then finding myself as a partner in a large semi urban practice, has brought with it many challenges.

Lots of newly qualified doctors will appreciate that when entering the working environment, it is difficult enough to get to grips with the workings and continuous changes in primary care, before even thinking of yourself as a future leader.

Junior partners are thought of as just that, junior colleagues, who are in need of shaping and moulding to comply with the pre-existing framework. Indeed it is incredibly hard starting a new job and finding your feet, particularly in the increasingly demanding work of the NHS.

But are we missing an opportunity? True innovation is what is going to save the NHS and preserve the future of our health economy. New people coming in to organisations bring fresh ideas and the potential for novel solutions to old and current problems. Of course there will also be existing experienced clinicians that have similarly novel ideas with the added benefit of lessons learnt from past actions.

With the main role of a GP being a provider they must show leadership for their patients, staff and colleagues within the practice.

For those of us who find ourselves working with the new clinical commissioning groups (CCGs), similar leadership skills are required within this new organisation with a mixture of clinicians and managerial colleagues, as well as to the broader community of stakeholders.

Leadership has to then be a key priority when we consider the development of our future NHS staff. Firstly though we should consider who will want to do this, when will they find the time and what resources are actually available out there.

What’s the role of leadership development?

As CCGs move forward there will be an increasing presence of clinicians having to make key and often controversial decisions about healthcare provision in their localities.

Many of these individuals have been thrown in at the deep end with little or no prior experience of commissioning or indeed leadership.

Clinicians tend to have a very systematic approach to any dilemma, which involves firstly gathering information and then making a conclusion. Often there is collaboration with other agencies and changes that occur along the way that will influence the eventual management plan. They will often be highly motivated and passionate about their vocation, highlighting one of the key reasons why clinicians have the potential for development as successful leaders.

Although the role of non-clinical managers is essential in this model, with the benefit of developing clinical leaders we may be tapping in to a resource which has previously remained detached from the world of commissioning and management.

As a sign of the times, many curricula are beginning to understand the importance of leadership development. An obvious first step is exposing undergraduate students to the concept of leadership before finishing medical school.

After training there are several paths one can take to develop leadership skills. In my opinion an important point that often gets overlooked is the benefit of experience. Gaining clinical and management experience through daily exposure in work has a huge role to play.

By providing an individual a chance to see how processes work from the inside, they can identify service improvement ideas which continues to enhance their leadership skills and knowledge. Indeed there are some jobs specifically developed to give management training with clinical work, but these are few and far between.

The NHS Institute for innovation and improvement is one source of assistance, promoting the use of the Medical Leadership Competency Framework.

This is a detailed framework, which highlights the areas essential to developing future leadership skills. It is a useful map of the areas to be given consideration in personal development for both managers and clinicians.

The National Leadership Academy is another organisation that provides a link to national programmes established to promote the development of future NHS leaders including the Clinical Leadership Fellowship programme upom which I attained a place.

The Royal Colleague of General Practitioners (RCGP) website has a section devoted to medical leadership with a link to the Faculty of Medical Leadership and Management.

There are also a variety of local and national networks in place to promote the sharing of good ideas and provide exposure to suitable programmes and seminars. The Clinical Leaders Network is one such organisation.

The King’s Fund has a large area on its website detailing information about various leadership training courses.

As becomes abundantly obvious, there is no shortage of free resources to get clinicians off the ground with regards to leadership training.

The Clinical Leadership Fellowship Programme

Being part of the NHS North East Essex CCG, I have been actively involved in service improvement projects on various scales. It became obvious to me from an early stage that I needed to develop my own leadership skills if I am to develop as a future leader.

The fellowship has been a fantastic source of development for me in my role as both a primary care physician and as a commissioner, through helping me to learn about aspects of organisational behaviour and culture that were not part of my undergraduate (or indeed postgraduate) training.

The programme commenced in 2012 after an initial application and assessment process, and was open to all clinicians working in the NHS. In order to qualify I needed to be part of a service improvement project that would provide patient benefit, and be the grounds for me to test my newly developed leadership skills.

The programme is delivered through the collaboration of two institutions. The King’s Fund use experiential learning to deliver a modular programme to enhance leadership skills and develop essential skills in practice. Coupled with this the University of Birmingham and Manchester Business School have developed a program of lectures encompassing various theoretical models and ideologies that can be used to analyse healthcare. The end result is hopefully to obtain a PGCert in leadership and Service improvement.

Leadership tools

Myers-Briggs Type Indicator (MBTI)

It is through the fellowship I gained exposure to MBTI personality typing. This has been an eye opener for me in terms of understanding individual personalities, and how best to integrate others members opinions in to a group or discussion. Although initially sceptical about its benefits, I have since learnt how useful this can be when considering both my negotiation skills and conflict resolution. I am certain this has had a beneficial influence on my leadership skills.


Belbin is a questionnaire used by many organisations to identify individuals specific team roles. What I find interesting is that through my development I appear to have taken on different roles, a sign of change. Along with my results from the MBTI these have both shown the ability to adapt my behaviour and understand the challenges in group work.


Through the CCG, I was given access to executive coaching. Although I have had two sessions so far, I have no doubt of its benefits for me in the long term. I have been able to set myself personal development goals and implement changes to achieve them.

Peer review tools

The leadership academy also funded a 360 leadership tool evaluation. The purpose of this is to assess me against the leadership with the aim of “creating the vision” and “delivering the strategy”.

Having had this opportunity I have been able to identify areas where I could clearly improve while also highlighting where my strengths lie. This has again been a useful evaluation tool enabling further development, aiding me individually and my working organisation.

Reflective learning

Throughout my career I can’t say that I have ever entertained the concept of self-reflection. Introduced to this through the King’s Fund via their organised action learning sets (ALS) I have really begun to see the benefits of this form of self assessment.

The ALS has been a great tool allowing me to test my new learning with other clinicians on the fellowship.

Being the only GP in the fellowship has not been a sticking point for me in any way. In fact I can safely say it has been very useful sharing the learning process with other professional colleagues. It is only a shame that in this cohort there was a distinct lack of GP’s.

At no point through my career have I knowingly been exposed to a curriculum designed to teach leadership skills.  As new CCG’s take form they will be infused with a mixture of experienced leaders and individuals new to this practice. What is clear is that the vast majority of these people may have had no formal leadership training, and will definitely benefit from engaging with the many opportunities available out there.

Consider though that at a time when we are being bombarded with outcome driven work, is this really a priority? Also what about the mind-set of these individuals. Do they understand the need to develop leadership skills, and would they therefore benefit from further opportunities to enhance these skills?

We must recognise that the future leaders of tomorrow’s NHS should take the time to entertain their leadership development. It is now a priority in medical training and should continue to be so as people progress through their career. Individuals may not always appreciate the need, but they will almost certainly see the benefit.

Dr Hasan Chowhan, Vice CCG lead North East Essex

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